Physiopathology of Intraoperative Visceral Ischemia and Anesthesiological Management of Supravisceral Aortic Clamping

Abstract

Vascular surgery, in which a supraceliac aortic clamp is required, is at highest risk of visceral ischemia and postoperative complications. The interruption of the blood flow to the organs, secondary to the artic cross-clamp, triggers cellular and molecular alterations with local and systemic effects. In particular, the tissues distal to the clamp become ischemic with a shift from aerobic to anaerobic metabolism. Since the reperfusion, following aortic clamp removal, may further increase the organ damage of the ischemic tissues, an ischemia/reperfusion (I/R) injury is usually observed during aortic surgery. The I/R injury is responsible for an extensive systemic inflammatory response which may trigger postoperative multi-organ failure. Polymorphonuclear neutrophils, oxygen radicals, nitric oxide, complement system, and cytokines are mainly involved in this double pathophysiological phenomenon.