A systematic review and meta-analysis of remote ischemic preconditioning for vascular surgery

Background: Remote ischemic preconditioning (RIPC) is a method of preparing the body for a later prolonged ischemic episode to protect against subsequent detrimental effects. This study aimed to identify the effects of RIPC in vascular surgery. Methods: A standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses search was conducted of randomized controlled trials of RIPC in patients undergoing open or endovascular aneurysm repair, carotid endarterectomy, or lower limb bypass reporting on mortality and renal or cardiac outcomes. Random-effects meta-analysis was performed using Review Manager 5.3 (The Nordic Cochrane Center, Copenhagen, Denmark). Results: A total of 13 randomized controlled trials in the meta-analysis included 548 patients in the RIPC cohort and 549 controls. There was no significant difference in mortality, renal dysfunction, myocardial infarction, myocardial injury, or length of stay between the groups, with subgroup and sensitivity analysis showing no significant difference. Conclusions: Current evidence demonstrates no benefit of RIPC in vascular surgery. Further large multicenter trials of RIPC in major vascular surgery should be considered.