Ischemia reperfusion injury on temporary aortic cross-clamping

Abstract

INTRODUCTION: Abdominal aortic cross-clamping is a procedure used by cardiovascular surgeons for surgical treatment of abdominal, thoracic, or thoracoabdominal aneurysms or peripheral vascular disease. Cross clamping of aorta causes ischemia of organs in distal area of the clamping. Prolonged ischemia during clamping can result in injury upon return of blood flow. This condition is known as ischemic reperfusion injury, a condition in which injury occurs as a result of disrupted blood supply to an organ (ischemia) followed by reperfusion. This article reviews existing evidence of ischemia-reperfusion injury as a result of abdominal aortic cross-clamping procedure.EVIDENCE ACQUISITION: The literatures reviewed and cited in this review were obtained from PubMed and Google Scholar database. The key words used were: “abdominal aortic cross-clamping,” “ischemia-reperfusion injury,” “abdominal aorta” and “cross-clamping.”EVIDENCE SYNTHESIS: Out of 20 articles gathered in this review, 1 article is a systematic review, 11 articles were animal experiment, 5 articles were observational studies, and 3 articles were clinical trial. Studies have generally established the association between cross-clamping of abdominal aorta with ischemia reperfusion injury in skeletal muscles, lower extremity, peripheral nerves, lungs, hemodynamic function, kidneys, digestive system, viscera, and spinal cord. Location of injury in spinal cord corresponds with the position of abdominal aortic cross-clamp. Duration of clamping affects the occurrence of ischemia-reperfusion injury, which are proven by the presence of proinflammatory cytokines and markers of cellular damage.CONCLUSIONS: Previous studies suggested that abdominal aortic cross-clamping can cause ischemia-reperfusion injury in organs located distal to the cross-clamping. Affected organs are determined by position of the abdominal aortic cross-clamp. The occurrence of ischemia-reperfusion injury in abdominal aortic cross-clamping is also affected by the duration of clamping.