Significance of Cold Renal Perfusion on Renal Function and Clinical Outcomes When Renal Ischemia Time Exceeded 30 Min during Pararenal and Juxtarenal Abdominal Aortic Aneurysm Surgery

Abstract

Objectives: To investigate the influence of cold renal perfusion on renal function and clinical outcomes in cases where the renal ischemia time exceeded 30 min during pararenal and juxtarenal abdominal aortic aneurysm (P/JAAA) surgery. Methods and Results: Fifty-four patients who underwent open repair for P/JAAAs were retrospectively analyzed. Thirty-nine patients received renal perfusion with cold Ringer's solution (perfusion group) and 15 patients did not receive renal perfusion (non-perfusion group). There were no significant differences in preoperative serum creatinine level (Cr) (1.08 ± 0.42 vs. 1.35 ± 0.71 mg/dL, p = 0.09), percentage of patients with Cr > 2 mg/dL [2/38 (5%) vs. 2/15 (13%), p = 0.8], and renal ischemia time during proximal aortic clamping (49 ± 21 vs. 47 ± 11 min; p = 0.8) between the groups. Postoperative Cr was significantly lower in the perfusion group than in the non-perfusion group (1.48 ± 0.76 vs. 2.23 ± 1.21 mg/dL, p < 0.01). The percentage of patients with postoperative Cr > 2 mg/dL was also significantly lower in the perfusion group than in the non-perfusion group [5 (13%) vs. 7 (47%), p < 0.01)]. At discharge, Cr returned to preoperative levels in both groups. All patients were discharged from the hospital without incidents. Conclusion: Renal artery perfusion with cold Ringer's solution clearly reduced the deterioration of postoperative renal function compared to non-renal perfusion.

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

“…14,37,47,48 Regarding the duration of aortic cross-clamping and CRP, O'Donnell and colleagues 14 found in a subgroup analysis that CRP tended to be of benefit in reducing AKI events when clamp duration exceeded 25 minutes. Although this has been replicated in other studies, [23][24][25] a preoperative method for determining an expected clamp duration has not been formally devised. Technical factors during complex open surgical repair determine renal outcomes.…”

“…[15][16][17][18][19][20][21] Championed by Crawford and colleagues, 22 CRP as a renalprotection strategy has been particularly useful in patients with prolonged aortic clamp time and renal ischemic time. 14,[23][24][25] The technique consists of inserting renal artery catheters and perfusing the kidneys with 4°C crystalloid fluid during periods of aortic cross-clamping. 16,18 Complex aortic aneurysms are localized, pathological dilations of the abdominal and/or thoracic aorta that may involve the renal or visceral branch vessels.…”