Routine continuous cold perfusion of the kidneys during elective juxtarenal aortic aneurysm repair.
OBJECTIVE
Surgical treatment of JAAs (juxtarenal aortic aneurysms) requires suprarenal aortic cross-clamping, causing temporary renal artery occlusion. We implemented a standardized protocol of hypothermic renal perfusion for all elective JAA operations.


METHODS
Retrospective study.


METHODS
Over a period of 6 years, 23 consecutive patients received a 300ml bolus followed by an infusion (20ml/minute) of cold (4 degrees C) saline to each kidney during suprarenal aortic clamping. We assessed outcome in terms of rise in serum creatinine, new onset of dialysis and mortality.


RESULTS
None of the patients suffered from postoperative acute renal failure and in-hospital mortality was zero. Five patients did not show any rise in serum creatinine level, whereas in the others rises were <25% in comparison with the admission level, except for one patient (38%). Postoperative rise in serum creatinine level was not related to renal ischemia time (Spearman rank correlation=0.24, p=0.27), preoperative renal function, total aortic clamping time or renal re-implantation. There were no renal complications at 6 months.


CONCLUSIONS
Our results suggest that a standardized strategy to apply renal hypothermia during the ischemic period of elective JAA surgery may reduce postoperative renal failure.
Yeung
K K
KK
Department of Surgery, Vrije Universiteit Medical Center (VUmc), Amsterdam, The Netherlands. k.yeung@vumc.nl
Jongkind
V
V
Coveliers
H M E
HM
Tangelder
G J
GJ
Wisselink
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D012077:Renal Artery; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents