Preservation of renal function in juxtarenal and suprarenal abdominal aortic aneurysm repair
| Autor: | Dirk S. Baumann, Charles B. Anderson, Brian G. Rubin, M. Wayne Flye, Brent T. Allen, Gregorio A. Sicard |
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| Rok vydání: | 1993 |
| Předmět: |
Male
medicine.medical_specialty Renal function Kidney chemistry.chemical_compound Aneurysm Postoperative Complications Renal Artery Hypothermia Induced medicine.artery medicine Humans Aorta Abdominal Renal Insufficiency Renal artery Aged Creatinine Intraoperative Care Renal ischemia business.industry Incidence Abdominal aorta medicine.disease Constriction Abdominal aortic aneurysm Surgery medicine.anatomical_structure chemistry Female Morbidity business Cardiology and Cardiovascular Medicine Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Vascular Surgery. 17:948-959 |
| ISSN: | 0741-5214 |
| DOI: | 10.1067/mva.1993.46197 |
| Popis: | Purpose: Deterioration in renal function is a common cause of morbidity in patients treated surgically for juxtarenal and suprarenal abdominal aortic aneurysms. We reviewed our experience over the last 8 years with 65 consecutive patients undergoing juxtarenal ( n = 31) or suprarenal ( n = 34) abdominal aortic aneurysm repair. Methods: The aneurysms were repaired with a transabdominal ( n = 8), thoracoabdominal ( n = 4), retroperitoneal ( n = 22), or thoracoretroperitoneal ( n = 31) approach. Proximal aortic clamps were placed at the suprarenal, supra-superior mesenteric artery, or supraceliac level. Renal hypothermia with cold heparinized saline solution renal artery perfusion was used to protect renal function in 38 patients with either preoperative renal insufficiency or with anticipated prolonged renal ischemia (> 30 minutes). Concomitant renal artery reconstruction was required in 30 patients. Results: Significant operative morbidity developed in 23 (35.3%) patients. There was one (1.53%) perioperative death (0 to 90 days). Temporary dialysis was necessary in two patients. Preoperative renal insufficiency was a significant risk factor on multivariate analysis for a decline in renal function during the first postoperative week. However, serum creatinine concentration had returned to baseline or improved in all patients but two (3.1%) at the time of discharge. In spite of significantly longer renal ischemia, discharge creatinine levels were, on univariate analysis, statistically less than baseline creatinine levels in patients with suprarenal aneurysms, patients requiring renal reconstruction, and patients treated with renal hypothermia. The location of the proximal aortic clamp was not a factor in postoperative morbidity. There was no significant difference between juxtarenal and suprarenal aneurysms with respect to operating room time, transfusion requirements, days intubated, resumption of oral diet, or the length of hospitalization. Conclusions: Careful consideration of the route of exposure, location of the proximal aortic clamp, and the preservation of renal function with renal hypothermia and with the repair of significant renal artery lesions will result in minimal morbidity and mortality in patients requiring surgery for juxtarenal or suprarenal abdominal aortic aneurysms. (J VASC SURG 1993;17:948-59.) |
| Databáze: | OpenAIRE |
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