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Does the sequence of clamp application during open abdominal aortic aneurysm surgery influence distal embolisation?
S E Webster1, J Smith, M M Thompson
1Department of Vascular Surgery, Leicester Royal Infirmary, UK.
Background:
Embolisation of atherosclerotic debris during abdominal aortic aneurysm (AAA) repair is responsible for significant peri-operative morbidity. Reports have suggested that preferential clamping of the distal vessel(s) before the proximal aorta may decrease the number of emboli passing distally and hence reduce complications.
Methods:
Forty patients undergoing AAA repair were randomised to have either first clamping of the proximal aorta or the iliac vessels. Emboli passing through the Superficial Femoral Arteries were detected with a Transcranial Doppler ultrasound system.
Results:
There was no difference between the two groups in the number of emboli detected (p=0.49) and no significant correlation between number of emboli and dissection time (r=0.0008). However, there was a significantly higher number of emboli in the patient sub-group that were current smokers (p=0.034).
Conclusions:
There appears to be no difference in the numbers of emboli detected when the first vascular clamp is applied to the proximal aorta or iliacs.