2021 Volume 30 Issue 6 Pages 335-340
Objectives: We studied the protective effects of renal arterial perfusion in patients with abdominal aortic aneurysm (AAA) requiring renal artery reconstruction. Methods: In our institute, renal protection is attempted when renal artery reconstruction is required and proximal anastomosis without renal artery reconstruction is performed under simple clamp even supra-renal clamp is necessary. Between April 2012 and July 2020, 307 patients with abdominal aortic aneurysm underwent surgery and 63 cases were included in this study after excluding patients who underwent endovascular stent-graft implantation or patients with infective aneurysm, ruptured aneurysm and chronic dialysis. For renal protection, the renal artery was perfused with warm arterial blood from 6 Fr. sheath placed in the left brachial artery via rapid infusion pump at flow rate of 100 mL/min or circuit pressure less than 150 mmHg, and this renal protection was applied for 7 patients (Group P). Simple aortic cross clamp was applied for 56 patients and these patients were divided into supra-renal clamp group (Group C, n=21) and infra-renal clamp group (Group N, n=35). Post-operative serial change of eGFR was compared between the three groups. Results: Pre-operative renal function did not differ significantly between the three groups. Averaged renal ischemic time was 30 minutes in group C and averaged renal ischemic and perfusion time was 129 minutes in Group P. Post-operative eGFR was significantly lower in Group C than Group N or POD1 (65.8±26.4 Vs. 47.7±25.2, p=0.018), and POD5 (79.7±22.5 Vs. 63.9±26.7, p=0.024). However, eGFR of Group P did not differ significantly from that of Group N throughout post-operative period. Conclusion: Renal arterial perfusion with warm arterial blood prevented renal failure in patients with abdominal aortic surgery requiring renal artery reconstruction, even in those with expected renal ischemic time was no longer than 120 minutes.
