Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Abstract

Objective: To investigate predictors of acute kidney injury (AKI) following open aortic repair (OAR) requiring suprarenal clamping. Methods: The study included 833 nonhemodialysis patients who had undergone elective OAR (with suprarenal clamping, n=73; with infrarenal clamping, n=760). We evaluated AKI as defined by the criteria of the Kidney Disease Improving Global Outcomes (KDIGO) and compared in-hospital outcomes between the two groups. We also investigated the effects of AKI on outcomes, factors related to post-suprarenal clamping AKI, and efficacy of hypothermic renal perfusion (HRP) in the suprarenal clamping group. Results: For the suprarenal vs. infrarenal clamping group, in-hospital mortality was 0% (0/73) vs. 0.5% (4/760). The incidence of AKI was greater in the suprarenal clamping group (37% vs. 15%, P<0.001), and the hospital stay for patients with AKI was longer than for those patients without AKI (median, 21 days vs. 16 days; P=0.005). Renal ischemia time and bleeding volume >1,000 mL were associated with post-suprarenal clamping AKI. Renal ischemia time was longer with HRP (n=15) than without HRP (n=58) (median, 51 min vs. 33 min; P=0.011), and HRP did not decrease the incidence of AKI (40% vs. 36%; P=0.78). Conclusion: Prolonged renal ischemia and substantial intraoperative bleeding are associated with postoperative AKI following suprarenal clamping.

Clinical Utility of Urinary Biomarkers for Prediction of Acute Kidney Injury and Chronic Renal Dysfunction After Open Abdominal Aortic Aneurysm Repair

“…Renal hypoperfusion induced during OSR is widely known as a major cause of AKI 16 , 17 and AKI appears to occur more often in association with suprarenal AXC than in association with infrarenal AXC, 4 , 17 a finding supported by the present study. Furthermore, AKI can lead to chronic renal dysfunction.…”

“…In addition, suprarenal AXC was found to be a significant, independent risk factor for occurrence of AKI. Renal ischemia time and intraoperative blood loss have been reported to be associated with OSR-related AKI when the surgery involves suprarenal AXC, 17 and the severity of acute renal dysfunction affects the degree of chronic renal dysfunction. 18 , 19 Although the estimated blood loss volume was similar between our patients who underwent infrarenal AXC and those who underwent suprarenal, the longer clamp time required for suprarenal AXC may explain, at least in part, the frequent occurrence of AKI and the deterioration in renal function.…”

Coarctação de aorta abdominal justarrenal associada à hipertensão renovascular e claudicação incapacitante: tratamento utilizando ponte ilíaco-birrenal e técnica “paving and cracking”

“…First, in situ reconstruction of the aorta with re-anastomoses of the renal arteries was ruled out in order to avoid suprarenal clamping and simultaneous bilateral renal ischemia, which could increase postoperative morbidity and risk acute renal failure. 18 , 19 Constructing a bilateral iliac-renal bypass with end-to-side anastomosis avoided prolonged renal ischemia. The configuration of the bypass was extrapolated from that recommended by Oderich et al for retrograde iliac-superior mesenteric reconstruction, since it increases long-term patency by reducing the risk of turbulence.…”

“…Dada a anatomia da lesão, algumas considerações a respeito do planejamento do procedimento devem ser destacadas. Primeiro, não foi optada pela reconstrução in situ da aorta com reanastomose das artérias renais para se evitar o clampeamento suprarrenal e a isquemia renal bilateral simultânea, o que poderia aumentar a morbidade pós-operatória com risco de insuficiência renal aguda 18 , 19 . Realizando uma ponte ilíaco-renal bilateral com anastomose término-lateral, não tivemos isquemia renal prolongada.…”

Efficacy of cold renal perfusion protection for open complex aortic aneurysm repair: a meta-analysis

“…atients undergoing major open surgical repair of complex aortic aneurysms (cAAs) are at heightened postoperative risk for acute kidney injury (AKI). [1][2][3][4][5][6][7][8][9] Renal insufficiency has been reported in up to 33.6% of patients in the postoperative period, 10 with a rate of newonset dialysis of 3.3%. 11 Previous observational literature in this patient population showed an all-cause mortality rate of 4.2% in the postoperative period, 10 which was partly attributed to the high incidence of renal failure.…”