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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2010 August;23(4):93-7
Preserving the renal function during suprarenal aortic clamping
Joh J-H., Cho Y-K., Lee K-B., Yun W-S., Park U-J., Kim Y-W., Roh Y-N., Kim D-I
1 Division of Vascular Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea
2 Department of Surgery, Kyung Hee University Medical Center Seoul, Korea
Aim. Aortic cross clamping is necessary when operating on patients who suffer with aortoiliac occlusive diseases (AIOD). However, if the occlusion presents close to the renal artery, then suprarenal aortic cross clamping is required. There are some methods to prevent renal failure during temporary suprarenal aortic cross clamping. The purpose of this study is to retrospectively report on the perioperative change of renal function after suprarenal aortic cross clamping in patients with AIOD.
Methods. From 2000 to 2008, 60 patients underwent aortic bypass surgery (aorto-biiliac or aorto-bifemoral bypass) at our institute. We retrospectively reviewed 7 of 48 patients who needed suprarenal aortic cross clamping. Heparin 50 u/kg, furosemide 20 mg and mannitol 12.5 g were injected before performing suprarenal aortic cross clamping for renal protection. The serum blood urea nitrogen (BUN) and creatinine levels were checked preoperatively and at the 1st postoperative hr, the 1st postoperative day, the 3rd day and the 5th day. CT angiography was used for follow up to detect any renal infarction.
Results. Six out of 7 patients were male and the patients’ ages ranged from 54 to 70 years. The range of the suprarenal aortic cross clamping time was from 5 to 15 minutes. We performed 4 aorto-bifemoral bypasses, 2 aorto-biiliac bypasses and 1 aorto-iliac/aorto-femoral bypass. In all the cases we performed end-to-end anastomosis for the aorto-graft anastomosis with using an ePTFE graft. The preoperative serum BUN level was 11.3-18.1 mg/dL, it was 6.0-11.5 mg/dL on the postoperative 1st h and it was 8.3 -15.8 mg/dL, 4.5-18.6 mg/dL and 4.6-15.2 mg/dL on the postoperative 1st day, 3rd day and 5th day, respectively. The preoperative serum creatinine level was 0.8-1.2 mg/dL. After the operation, it was 0.56-1.4 mg/dL on the 1st postoperative hour and it was 0.67-1.4 mg/dL, 0.61-1.2 mg/dL and 0.54-1.1 mg/dL on the postoperative 1st day, 3rd day and 5th day, respectively. None of the patients developed renal infarction, as noted on the postoperative CT angiography.
Conclusions. None of the 7 patients developed renal failure after temporary suprarenal aortic cross clamping. However, there are important adjuncts for achieving renal protection such as bilateral renal artery occlusion during aortic clamping to prevent thromboembolism, routine administration of intravenous mannitol and furosemide before clamping and flushing of the aortic debris before restoring renal perfusion.