Impact of arterial cross-clamping during vascular surgery on arterial stiffness measured by the augmentation index and fractal dimension of arterial pressure

TERESA POLITI; JULIEN GAUDRIC; CAPURRO CLAUDIA; SANDRA WRAY; ARTHUR GHIGO; JUAN FERNADEZ; JOSE-MARIA FULLANA; PIERRE-YVES LAGRÉE; RICARDO ARMENTANO

Health and Ttechnology

SPRINGER

Año: 2016

2190-7188

Arterial cross-clamping is a common strategy used invascular surgery and its duration is an independent predictor ofsurgical outcomes. The impact of arterial cross-clamping on theviscoelastic properties of the arterial system and its underlyingmechanisms still remain unclear. The aim of this study was toevaluate the effect of arterial cross-clamping on arterial stiffness.A cross-sectional, observational, before-after study was designedto enroll adult patients undergoing vascular surgery. TheAugmentation Index normalized to 75 beats-per-minute(AIx@75) and Fractal Dimension (FD) ?indirect indicators ofarterial stiffness? were calculated from radial arterial pressuretracings during surgery. The arterial pressure tracings from 8patients were analyzed. Overall data included 4 aortic and 11iliofemoral interventions. In both aortic and iliofemoral interventions,after arterial clamping, median AIx@75 rose and FDdropped significantly; the opposite occurred after arterialunclamping. Spearman?s correlation suggests a strong significantnegative correlation between median AIx@75 and FD duringeach hemodynamic state for aortic interventions. Our resultsare consistent at many levels: a) opposite events (i.e., clampingand unclamping) produce changes in different directions, b) twodifferent indicators (i.e., AIx@75 and FD) suggest the sameunderlying phenomenon, and c) similar results are observed atdifferent vascular locations (i.e., aortic and iliofemoral). Overall,our data consistently suggests an increase in arterial stiffnessduring clamping and a reduction during unclamping. Despitethe large distance fromthe aortic or iliofemoral intervention sites,radial artery pressure monitoring is still able to detect consistentlythese vascular events.