title: Temporary Axillorenal Bypass in Complex Aorto-Renal Surgery.
abstract: BACKGROUND
  Prolonged renal ischemia during vascular surgery carries high morbidity and mortality. We report an alternative technique for maintaining renal circulation during suprarenal aortic or renal artery clamping.
  
  
  METHODS
  Between October 2007 and May 2012, 16 patients undergoing aorto-renal surgery (13 men, 3 women) were operated using temporary axillorenal bypass. Operations were performed for supra- and juxtarenal aortic aneurysms (11), occlusive aortic disease (2), renal artery stenoses (2), and abdominal myofibroblastic tumor (1). In elective cases, axillorenal bypass was planned, when prolonged renal ischemia was expected based on preoperative information. Preoperative risk factors (renal dysfunction, hypertension, coronary disease, diabetes, smoking) and intraoperative variables (operating time, blood loss, renal ischemia time) were assessed and compared with postoperative kidney function (serum creatinine, urine output, dialysis) and in-hospital or 30-day-mortality. Even though renal blood flow was restored between clampings, the total cumulative ischemia time was used in analysis. Acute renal failure postoperatively was based on RIFLE criteria.
  
  
  RESULTS
  Preoperatively, 44% (7) of the patients had normal renal function (S-crea ≤ 100 mmol/L). Renal function was moderately present in 50% (8) (S-crea 100-200 mmol/L) and severely in 6% (1) (S-crea ≥ 200 mmol/L). Median operation time was 393 min (251-535 min) and median renal ischemia time was 24.5 min (range 8-50 min). Transient acute renal dysfunction occurred in 6 (38%) patients, and 4 of them had renal insufficiency preoperatively. Transient renal replacement therapy was needed in 1 (6%) patient only. In 1-month control, postoperative renal function had returned to its baseline level or improved and in-hospital or 30-day mortality was zero.
  
  
  CONCLUSIONS
  Temporary axillorenal bypass is a considerable option to minimize renal ischemia time during high-risk vascular surgery.
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland. Electronic address: ivikah@hotmail.com.
authors.forename: Ivika
authors.initials: I
authors.lastname: Heinola
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Karoliina
authors.initials: K
authors.lastname: Halmesmäki
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kantonen
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Pirkka
authors.initials: P
authors.lastname: Vikatmaa
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Aho
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D000368:Aged; D000714:Anastomosis, Surgical; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000503:physiopathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003250:Constriction; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012077:Renal Artery / Q000503:physiopathology / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012079:Renal Circulation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome