Renal dysfunction after vascular surgery.
OBJECTIVE
The purpose of this review is to focus on the static incidence of renal dysfunction, the lack of evidence of benefit of traditional renoprotective strategies, and newer techniques that may provide an insight into the mechanisms of acute perioperative renal injury associated with vascular surgery.


RESULTS
Recent studies that have investigated the long-term results of aortic surgery still report a significant incidence of postoperative renal dysfunction. This finding remains consistent in several reports. However, less invasive techniques such as endovascular repair seem to be associated with reduced inflammation and postoperative renal dysfunction. The possible association between genetic heterogeneity and renal dysfunction in vascular surgical patients is an exciting new area of research.


CONCLUSIONS
Renal dysfunction after major vascular surgery remains a significant problem. New insights into the mechanisms of acute renal injury and less invasive techniques of vascular repair may help reduce the incidence of renal dysfunction in this patient population. The lack of a truly 'renoprotective' agent has hampered our efforts in preventing this major complication of vascular surgery.
Swaminathan
Madhav
M
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. swami001@mc.duke.edu
Stafford-Smith
Mark
M