Ischaemic Preconditioning: The Rationale and Evidence-Based Outcomes
Reperfusion injury is a process well recognised and understood by vascular surgeons where return of arterialised blood flow to a previously ischaemic organ or tissue often results in a complex pathophysiological cascade ending in potentially irreversible cellular damage. The sequelae of this process are frequently seen in vascular surgery after reperfusion of a previously ischaemic lower limb. The resulting profoundly acute inflammatory syndrome gives rise to raised compartmental pressure within the muscles of the lower limb requiring fasciotomy. Reperfusion injury however can develop in several other surgical scenarios including coronary artery bypass grafting and other cardiac interventions, organ transplantation and major vascular surgery, in particular aortic aneurysm repair and carotid endarterectomy. Obviously in these scenarios, fasciotomy is not an option, and since the 1980s, there has been research into avoiding or at least mitigating reperfusion injury.
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