Is it safe to ligate the left renal vein during open abdominal aortic aneurysm repair?
BACKGROUND
Open repair of juxta-renal abdominal aortic aneurysms (AAA) sometimes involves the ligation and division of the left renal vein (LRV). Some surgeons advocate repair, but this is not common practice. The aim was to study the effect of LRV ligation on renal function.


METHODS
A retrospective audit of all open AAA repairs between February 2004 and September 2007 in our unit was completed. Pre- and postoperative renal function was assessed with the estimated glomerular filtration rate (eGFR), using an established formula.


RESULTS
Two hundred sixty-one open AAA repairs were performed in the study period. The LRV was ligated in 18.8%; mean age was 75.5 years, 35 were men, mean AAA diameter was 7.8 cm, there were 7 elective, 22 urgent, and 19 emergency AAA repairs. Renal function with LRV ligated was compared with the 212 patients without LRV ligation by independent samples t-testing. The baseline mean serum creatinine and glomerular filtration rate in the LRV ligated group were 115.1 micromol/L and 60.6, respectively, which were similar to the LRV not ligated group (p > 0.05). The renal function at postoperative day 1, day 7, and weeks 2-6 was similar in the two groups (p > 0.05). The postoperative renal function on day 1 was significantly worse compared to baseline (p < 0.05), but not at day 7 and weeks 2-6 (p > 0.05).


CONCLUSIONS
In patients undergoing LRV ligation, there is an initial drop in renal function which improves over 2-6 weeks. At each stage, the renal function is similar to patients in whom the LRV is not ligated. LRV ligation is safe during open AAA repair.
Mehta
Tapan
T
Norfolk and Norwich University Hospital, Colney Road, Norwich, UK.
Wade
Ryckie G
RG
Clarke
James M F
JM
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D004739:England; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D008026:Ligation; D008297:Male; D008485:Medical Audit; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
D015415:Biomarkers; D003404:Creatinine