title: Ex vivo renal repair: technical tips, when, and why.
abstract: Ex vivo renal artery repair combined with cold perfusion protection is an operative technique for managing complex renal artery lesions. Most diseases of the renal artery are proximal, and typically treated either medically, by endovascular means, or surgically. When surgery of the main renal artery is required, it can typically be performed with warm renal ischemia times of <30 minutes. However, in more distal disease, which can involve the segmental branches, a much more complicated surgical reconstruction can be anticipated. This often will necessitate warm ischemia times of >45 minutes, and can lead to direct renal nephron damage. In this setting, the ex vivo technique with cold perfusion can allow for lengthy reconstructive times of several hours without any measurable harm to renal function. The technique can be performed with low morbidity and mortality, an excellent rate of renal salvage, and preservation of renal function.
authors.affiliation: University of Maryland School of Medicine, Maryland Vascular Center, University of Maryland Baltimore Washington Medical Center, 301 Hospital Drive, Glen Burnie, MD 21061.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Nelms
authors.affiliation: University of Maryland School of Medicine, Maryland Vascular Center, University of Maryland Baltimore Washington Medical Center, 301 Hospital Drive, Glen Burnie, MD 21061. Electronic address: mbenjamin@bwmc.umms.org.
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Benjamin
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography / Q000379:methods; D050377:Cold Ischemia / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D056888:Patient Positioning; D011300:Preoperative Care / Q000379:methods; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012079:Renal Circulation / Q000502:physiology; D051437:Renal Insufficiency / Q000517:prevention & control; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D052096:Warm Ischemia