Remote Ischemic Preconditioning Prior to Vascular Surgery (CRIPES)
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Purpose
We have previously shown that elective vascular surgery is a high-risk operation with an anticipated risk of either death or heart attack of 15%. This study is testing whether a protocol of remote ischemic preconditioning (RIPC) applied 24 hours prior to the operation is safe, feasible and reduces the incidence of an adverse, perioperative cardiac complication.
| Condition | Intervention | Phase |
|---|---|---|
|
Peripheral Arterial Disease Vascular Surgery |
Procedure: Preconditioning Procedure: Control |
Phase 1 Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Subject) Primary Purpose: Prevention |
| Official Title: | Cardiac Remote Ischemic Preconditioning Prior to Elective Major Vascular Surgery |
- Troponin I elevation above the URL [ Time Frame: Within 3 days of the vascular operation ] [ Designated as safety issue: No ]Troponin I is biomarker of myocardial necrosis
| Estimated Enrollment: | 180 |
| Study Start Date: | September 2011 |
| Estimated Study Completion Date: | July 2015 |
| Estimated Primary Completion Date: | April 2015 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Placebo Comparator: Arm 1
Blood pressure cuff inflated to 40-50 mmHg in the upper extremity
|
Procedure: Control
Blood pressure cuff inflated to 40-50 mmHg in the upper extremity
Other Name: Control
|
|
Experimental: Arm 2
Blood pressure cuff inflated to 200 mmHg in the upper extremity for 5 minutes to cause forearm ischemia by external compression of the brachial artery. This will be followed by 5 minutes of cuff deflation to allow for preperfusion. The ischemia-reperfusion cycle will be repeated 3 times for a total duration of 30 minutes, equally divided between ischemia and reperfusion.
|
Procedure: Preconditioning
Blood pressure cuff inflated to 200 mmHg in the upper extremity for 5 minutes to cause forearm ischemia by external compression of the brachial artery. This will be followed by 5 minutes of cuff deflation to allow for preperfusion. The ischemia-reperfusion cycle will be repeated 3 times for a total duration of 30 minutes, equally divided between ischemia and reperfusion.
|
Detailed Description:
The proposed investigation has a single blind, randomized design and plans to enroll 180 patients who are scheduled to have major, elective vascular surgery for occlusive carotid disease, expanding AAA, occlusive lower extremity disease and/or critical limb ischemia at the Minneapolis VA Health Care Center. 24 hours prior to the patient's scheduled vascular operation, RIPC therapy will be applied to one of the participant's upper arms to cause forearm ischemia. Clinically collected, pre-operative troponins, CK-MBs, EKGs along with troponins, CK-MBs and EKGs collected on day 1, 2, 3 and day 7 (if still hospitalized) will be utilized to evaluate the occurrence of perioperative, adverse cardiac events.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Undergoing elective major vascular surgery at the Minneapolis VA Medical Center for abdominal aortic aneurysm, carotid disease or limb ischemia.
- Age > 18.
- Provides informed consent.
Exclusion Criteria:
- Hypertensive crisis
- Peripheral arterial disease of the upper extremities
- AV fistula
- ACS in the last 6 months
- Severe valvular heart disease
- Pregnant women
- Unable to provide consent
Contacts and Locations| Contact: Santiago A Garcia, MD | (612) 725-2000 ext 3662 | Santiago.Garcia@va.gov |
| United States, Minnesota | |
| Minneapolis VA Health Care System, Minneapolis, MN | Recruiting |
| Minneapolis, Minnesota, United States, 55417 | |
| Contact: Santiago A Garcia, MD 612-725-2000 ext 3662 Santiago.Garcia@va.gov | |
| Principal Investigator: Santiago A. Garcia, MD | |
| Principal Investigator: | Santiago A. Garcia, MD | Minneapolis VA Health Care System, Minneapolis, MN |
More Information
No publications provided
| Responsible Party: | Department of Veterans Affairs |
| ClinicalTrials.gov Identifier: | NCT01558596 History of Changes |
| Other Study ID Numbers: | CLIN-014-11F |
| Study First Received: | March 16, 2012 |
| Last Updated: | January 23, 2013 |
| Health Authority: | United States: Federal Government |
Additional relevant MeSH terms:
|
Peripheral Arterial Disease Peripheral Vascular Diseases Atherosclerosis Arteriosclerosis |
Arterial Occlusive Diseases Vascular Diseases Cardiovascular Diseases |
ClinicalTrials.gov processed this record on May 23, 2013