Short-term pre-operative dietary restriction in vascular surgery

Abstract

In this thesis we interrogated the benefits of short-term DR in (cardio)vascular surgery and vascular remodeling. A short-term reduction in proteins or amino acids is effective in mitigating the surgical and vascular response to injury, both via improved perioperative glucose homeostasis and a favorable vascular remodeling phenotype. Short-term DR increased endogenous levels of H2S, while a DR-mimetic was able to deliver exogenous H2S locally and sufficiently. Both endogenous and exogenous H2S upregulation stands as effective strategies to mitigate revascularization failure and warrant future studies in other (vascular) surgery models. The finding that diet favorably modulates adipose tissue phenotype is another underlying mechanism of action with enormous potential beyond vein graft surgery, since essentially all surgical procedures involve adipose tissue manipulation. In vascular surgery patients, short-term DR is feasible and safe, and we gained valuable insights in the response in surgical patients to dietary preconditioning.