Postoperative renal function after juxtarenal aortic aneurysm repair with simple cross-clamping

Hirofumi Kasahara, Hideyuki Shimizu, Ryohei Yozu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: We report our 11-year experience of juxtarenal aortic aneurysm (JAA) repair with suprarenal aortic cross-clamping. Methods: We retrospectively reviewed 51 consecutive JAA repairs performed between 2000 and 2010. In all 51 patients, aneurysms were replaced by prosthetic grafts with simple suprarenal aortic cross-clamping. No special renal protective measures (except inter-renal cross-clamping) were performed during interruption of perfusion to kidneys. For inter-renal cross-clamping, the aortic cross-clamp was placed from below one renal artery to above the other renal artery to maintain hemilateral renal perfusion. This technique was applied in 27 patients (54%). Postoperative complications, renal function, and survival were evaluated. Results: There were no deaths. The average renal ischemia time was 28.9 ± 9.7 minutes. Postoperatively, transient renal failure (defined as an estimated glomerular filtration rate of <30 mL/min/1.73 m2) occurred in 14% of the patients. The postoperative decrease of estimated glomerular filtration rate compared with the preoperative value was significantly smaller in the inter-renal clamp group (7.4% ± 16%) than in the suprarenal clamp group (17.5% ± 16%) (P < 0.05, unpaired t test). However, renal dysfunction was temporary and recovered to baseline before discharge with conservative therapy in all patients except one. In addition, renal function was generally preserved at 1 year after surgery. Conclusion: Surgical repair of JAA can be performed with simple cross-clamping and an acceptable renal ischemic time, achieving excellent results. Inter-renal cross-clamping reduces renal damage compared with suprarenal cross-clamping.

Original languageEnglish
Pages (from-to)291-298
Number of pages8
JournalAnnals of Vascular Surgery
Volume27
Issue number3
DOIs
Publication statusPublished - 2013 Apr

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Aortic Aneurysm
Constriction
Kidney
Renal Artery
Glomerular Filtration Rate
Perfusion
Renal Insufficiency
Aneurysm
Ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Postoperative renal function after juxtarenal aortic aneurysm repair with simple cross-clamping. / Kasahara, Hirofumi; Shimizu, Hideyuki; Yozu, Ryohei.

In: Annals of Vascular Surgery, Vol. 27, No. 3, 04.2013, p. 291-298.

Research output: Contribution to journalArticle

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abstract = "Background: We report our 11-year experience of juxtarenal aortic aneurysm (JAA) repair with suprarenal aortic cross-clamping. Methods: We retrospectively reviewed 51 consecutive JAA repairs performed between 2000 and 2010. In all 51 patients, aneurysms were replaced by prosthetic grafts with simple suprarenal aortic cross-clamping. No special renal protective measures (except inter-renal cross-clamping) were performed during interruption of perfusion to kidneys. For inter-renal cross-clamping, the aortic cross-clamp was placed from below one renal artery to above the other renal artery to maintain hemilateral renal perfusion. This technique was applied in 27 patients (54{\%}). Postoperative complications, renal function, and survival were evaluated. Results: There were no deaths. The average renal ischemia time was 28.9 ± 9.7 minutes. Postoperatively, transient renal failure (defined as an estimated glomerular filtration rate of <30 mL/min/1.73 m2) occurred in 14{\%} of the patients. The postoperative decrease of estimated glomerular filtration rate compared with the preoperative value was significantly smaller in the inter-renal clamp group (7.4{\%} ± 16{\%}) than in the suprarenal clamp group (17.5{\%} ± 16{\%}) (P < 0.05, unpaired t test). However, renal dysfunction was temporary and recovered to baseline before discharge with conservative therapy in all patients except one. In addition, renal function was generally preserved at 1 year after surgery. Conclusion: Surgical repair of JAA can be performed with simple cross-clamping and an acceptable renal ischemic time, achieving excellent results. Inter-renal cross-clamping reduces renal damage compared with suprarenal cross-clamping.",
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