Abstract
We perfused the kidneys with cold Ringer's solution during pararenal abdominal aortic aneurysm (AAA) surgery requiring suprarenal aortic cross-clamping, aiming to protect renal function. From January 2001 to October 2005, 15 patients, excluding patients on hemodialysis, underwent pararenal AAA surgery that required some form of suprarenal aortic cross-clamping and perfusion with cold Ringer's solution. The average patient age was 72±6 years, and all were men. Maximum AAA diameter was 54±8 mm. A transperitoneal approach was selected for all. Of 11 who underwent bilateral suprarenal aortic cross-clamping, both renal arteries were perfused with cold Ringer's solution in 7, and one artery in 4. In the 4 patients undergoing unilateral suprarenal aortic cross-clamping, the affected renal artery was perfused in all. Two patients had aneurysms that required renal artery reconstruction. Duration of renal exclusion was 46±23 min. Although delayed bleeding necessitated repeat laparotomy in 1 patient, no hospital deaths occurred and no patient needed to begin hemodialysis. Mean postoperative blood urea nitrogen (BUN) and serum creatinine (CRE) were 20.6±7.2 mg/dl and 1.43±0.80 mg/dl respectively, both significantly higher than preoperative levels (P=0.046 and 0.02, respectively). However, BUN and CRE soon returned to preoperative serum concentrations. BUN and CRE did not differ significantly between patients with prolonged renal ischemia (≥45 min) and those with briefer ischemia at any time. Duration of renal ischemia and postoperative percent change in BUN and CRE were unrelated except in patients with renal ischemia exceeding 60 min. Thus, perfusion with cold Ringer's solution proved safe and effective, in protecting renal function.
