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REVIEW CURRENT TREND IN THORACOABDOMINAL AORTIC ANEURYSM SURGERY - PART 2
The Journal of Cardiovascular Surgery 2021 August;62(4):326-38
DOI: 10.23736/S0021-9509.20.11745-2
Copyright © 2020 EDIZIONI MINERVA MEDICA
lingua: Inglese
Kidney protection in thoracoabdominal aortic aneurysm surgery
Diletta LOSCHI ✉, Andrea MELLONI, Andrea KAHLBERG, Roberto CHIESA, Germano MELISSANO
Division of Vascular Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
Acute kidney injury (AKI) is a common complication of both open and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). Its definition varies across difference studies, some standardized definitions (RIFLE, AKIN, KDIGO) have been proposed but still not uniformly employed in published papers. Acute kidney injury is multifactorial and is associated with increased in-hospital mortality, long-term mortality and late renal function decline. In addition, AKI is also associated with perioperative spinal cord ischemia. No specific pharmacological strategy has received a strong recommendation with high level of evidence as a protective measure. Fenoldopam, methylprednisolone or mannitol use to prevent AKI is commonly employed, but not supported by literature data. Avoiding nephrotoxic drugs and maintaining an adequate MAP, during and after the procedure plays a key role in preserving kidney function. During open TAAA surgery, renal arteries may be reimplanted using different techniques. The choice of the best option must be tailored to the patient, to reduce ischemic time and guarantee long-term patency. Current experience suggests that cold crystalloid solutions are the best substrates in preventing ischemia-reperfusion injury. Renal perfusion using Custodiol® (Dr Franz-Kohler Chemie GmbH; Bensheim, Germany) 4 °C, even if currently considered off-label, represents an encouraging organ protection tool. In endovascular TAAA repair, techniques such as fusion imaging, use of diluted contrast, and CO
KEY WORDS: Aortic aneurysm, thoracic; Acute kidney injury; Renal insufficiency; Aorta; Angioplasty