Abstract
Objectives: To investigate the influence of cold renal perfusion on renal function and clinical outcomes in cases where the renal ischemia time exceeded 30 min during pararenal and juxtarenal abdominal aortic aneurysm (P/JAAA) surgery. Methods and Results: Fifty-four patients who underwent open repair for P/JAAAs were retrospectively analyzed. Thirty-nine patients received renal perfusion with cold Ringer’s solution (perfusion group) and 15 patients did not receive renal perfusion (non-perfusion group). There were no significant differences in preoperative serum creatinine level (Cr) (1.08 ± 0.42 vs. 1.35 ± 0.71 mg/dL, p = 0.09), percentage of patients with Cr > 2 mg/dL [2/38 (5%) vs. 2/15 (13%), p = 0.8], and renal ischemia time during proximal aortic clamping (49 ± 21 vs. 47 ± 11 min; p = 0.8) between the groups. Postoperative Cr was significantly lower in the perfusion group than in the non-perfusion group (1.48 ± 0.76 vs. 2.23 ± 1.21 mg/dL, p 2 mg/dL was also significantly lower in the perfusion group than in the non-perfusion group [5 (13%) vs. 7 (47%), p Conclusion: Renal artery perfusion with cold Ringer’s solution clearly reduced the deterioration of postoperative renal function compared to non-renal perfusion.
Highlights
Abdominal aortic aneurysms (AAAs) are increasingly treated by endovascular aortic repair (EVAR), pararenal and juxtarenal abdominal aortic aneurysms (AAAs) (P/JAAAs) represent a growing number of conditions requiring open repair [1] [2]
There were no significant differences in preoperative serum creatinine level (Cr) (1.08 ± 0.42 vs. 1.35 ± 0.71 mg/dL, p = 0.09), percentage of patients with Cr > 2 mg/dL [2/38 (5%) vs. 2/15 (13%), p = 0.8], and renal ischemia time during proximal aortic clamping (49 ± 21 vs. 47 ± 11 min; p = 0.8) between the groups
Juxtarenal AAA is defined as an aneurysm that necessitates suprarenal or inter-renal proximal clamping for open surgery with infrarenal reconstruction
Summary
Abdominal aortic aneurysms (AAAs) are increasingly treated by endovascular aortic repair (EVAR), pararenal and juxtarenal AAAs (P/JAAAs) represent a growing number of conditions requiring open repair [1] [2]. Surgical treatment of P/JAAAs requires suprarenal aortic cross-clamping, causing temporary renal artery occlusion. Suprarenal clamping is associated with frequent renal impairment and higher mortality and morbidity rates [1]-[6]. The risk of postoperative renal failure increases with longer durations of suprarenal clamping, especially when the ischemia period exceeds 30 - 45 min [1] [7] [8]. Cold renal perfusion during suprarenal clamping has been performed. It was performed mostly in selected patients with preoperative renal insufficiency or when longer renal ischemia was anticipated; none of the studies compared the effects of cold renal perfusion with a control group. Its efficacy has not been definitively determined [9]
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