Evaluation of the Efficacy of Ischemic Preconditioning to Protect Against Acute Kidney Injury After Open Surgery for Juxtarenal Abdominal Aortic Aneurysm

N/ANot Yet RecruitingNCT07441564

University Hospital, Rouen206 enrolled

Overview

Juxta-renal abdominal aortic aneurysms (AAA) are challenging to treat with standard endovascular techniques (EVAR) due to their proximity to the renal arteries. Open surgical repair continues to be used in patients unsuitable for EVAR but carries a high risk of acute kidney injury (AKI), up to 24%. Postoperative AKI is a strong predictor of both short- and long-term cardiovascular mortality. The KDIGO criteria are used to better define and stage AKI. Pharmacological prevention strategies have shown limited effectiveness, prompting interest in ischemic preconditioning (IPC). Remote IPC has shown mixed results in cardiac and vascular surgery, depending on patient risk and protocols used. Local IPC, applied directly near the renal arteries, has shown promising renal protection in animal models. However, this technique has never been clinically tested in humans. We propose here a randomized trial to assess the efficacy of local IPC before suprarenal aortic clamping during open repair of juxta-renal AAA to reduce postoperative AKI.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Enrollment

206

Conditions

Aneurysm Aortic

Interventions

Experimental group (arm 1) consists of patients receiving open juxtarenal aortic aneurysm surgery with direct preconditioning by clamping the suprarenal aorta, which starts after randomization. The procedure for IPC will be achieved by two cycles of supra-renal aortic cross clamping during 5 minutes followed by an unclamping period of 5 minutes before starting the supra-renal aortic cross clamping needed to perform surgery. The level of aortic cross clamping used for IPC will be that required for aortic repair.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged 18-85 years * Patients with juxtarenal abdominal aortic aneurysms scheduled for open surgery * Patients with juxtarenal abdominal aortic aneurysms, which require suprarenal aortic cross clamping * Patients with juxtarenal abdominal aortic aneurysms, which are of atheromatous etiology or which developed after aortic dissection * Affiliation with, or beneficiary of a Social security (national health insurance) scheme * Adult having read and understood the information letter and signed the consent form * Women of childbearing potential with effective contraception according WHO definition (estrogen-progestin contraception or intrauterine device or male condom) since at least 1 month with a negative blood pregnancy test by b-HCG at inclusion. * Women surgically sterile (absence of ovaries and/or uterus or tubal ligation) * Postmenopausal women: confirmation of non-medically induced amenorrhea since at least 12 months prior to the inclusion visit Exclusion Criteria: * Patients dependent from dialysis * Patients with aortic aneurysms, which require reconstruction of the visceral arteries * Patients with aortic aneurysms, which require supra-visceral aortic cross clamping * Patients with wall thrombus or calcification of inter- and suprarenal aorta * Patients with septic aortitis * Patients with aneurysm requiring stent graft (EVAR) explantation * Patients requiring emergency surgery * Patients receiving treatments that may interact with preconditioning: Nicorandil and Glibenclamide * Pregnant or parturient or breastfeeding woman or absence of proven contraception * Person deprived of liberty by an administrative or judiciary decision or person placed under judicial protection, under guardianship or curatorship * Person participating to another trial during the month before randomization * Medical history or psychological or sensorial abnormality prone to inhibit the subject to understand the conditions required for his/her participation to the protocol or unable to give an informed consent

Outcomes

Primary Outcomes

To demonstrate the efficacy of ischemic preconditioning (IPC) applied closely to the supra-renal aorta with respect to the occurrence of Acute Kidney Injury (AKI) among patients undergoing open juxtarenal aortic aneurysm surgery.

The primary endpoint is the occurrence of a postoperative AKI of stage \> 1 before the morning visit on day 8. We use the KDIGO work group's definition of AKI.

Time frame: Day 8