The impact of aortic clamping site on glomerular filtration rate after juxtarenal aneurysm repair

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Abstract

Background: Open repair of juxtarenal abdominal aortic aneurysms (JAAAs), which necessitates clamping above one (interrenal clamping, interRC) or both renal arteries (suprarenal clamping, supraRC), is associated with an increased risk of perioperative renal derangements. We reviewed our experience to investigate the impact of aortic clamping site during JAAA repair on peri- and postoperative glomerular filtration rate (GFR). Methods: Between January 2001 and March 2006, 32 patients (28 male, four female; mean age 70.5 ± 5.6 years) were submitted to elective open repair of JAAA. SupraRC was required in 12 patients and performed with cold renal perfusion (CRP) in five cases; interRC was required in 20 and performed with CRP in eight. GFRs were estimated through postoperative day 4 using the Cockcroft-Gault equation and compared to those of concurrent controls undergoing infrarenal AAA repair, matched 1:1 by gender, age, aneurysm size, preoperative GFR, and left renal vein management. GFR values were also evaluated and compared between groups at a mean follow-up of 29.0 ± 23.7 months. Renal dysfunction was defined as a decrease of GFR ≥20%. Statistics were determined as appropriate for the variables of interest. Results: No perioperative mortality was recorded and no differences in major complication rates were observed between groups (p = 0.16). Operative time was longer in JAAA patients (154 ± 47 vs. 132 ± 41 min, p = 0.019). Mean renal ischemia time was 16.7 ± 7.7 min. Postoperatively, GFR values up to day 4 were significantly worse in JAAA patients compared to controls (p = 0.0007), with a fourfold risk of renal dysfunction at postoperative day 4 (34% vs. 9%, odds ratio [OR] = 4.44, 95% confidence interval [CI] 1.1-18.1; p = 0.029). At univariate analysis, supraRC was found to be the only factor associated with perioperative renal dysfunction (OR = 11.3, 95% CI 2.0-63.1; p = 0.003). At follow-up, two patients with supraRC died and another two required dialysis permanently. When compared to those with interRC or infrarenal clamping, patients with supraRC showed a persistent renal dysfunction at follow-up (p = 0.005). Conclusion: Elective JAAA repair with renal ischemia time ≤30 min is safe, but supraRC entails a significant perioperative and mid-term GFR reduction. In contrast, interRC provides results similar to those obtained after infrarenal AAA repair, allowing postoperative recovery of renal function to preoperative values.

Original languageEnglish
Pages (from-to)770-777
Number of pages8
JournalAnnals of Vascular Surgery
Volume23
Issue number6
DOIs
Publication statusPublished - Nov 2009

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Glomerular Filtration Rate
Constriction
Aneurysm
Abdominal Aortic Aneurysm
Kidney
Ischemia
Perfusion
Odds Ratio
Confidence Intervals
Renal Veins
Recovery of Function
Renal Artery
Operative Time
Dialysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{84e4aefa528c4e7a8bac87d43c54904a,
title = "The impact of aortic clamping site on glomerular filtration rate after juxtarenal aneurysm repair",
abstract = "Background: Open repair of juxtarenal abdominal aortic aneurysms (JAAAs), which necessitates clamping above one (interrenal clamping, interRC) or both renal arteries (suprarenal clamping, supraRC), is associated with an increased risk of perioperative renal derangements. We reviewed our experience to investigate the impact of aortic clamping site during JAAA repair on peri- and postoperative glomerular filtration rate (GFR). Methods: Between January 2001 and March 2006, 32 patients (28 male, four female; mean age 70.5 ± 5.6 years) were submitted to elective open repair of JAAA. SupraRC was required in 12 patients and performed with cold renal perfusion (CRP) in five cases; interRC was required in 20 and performed with CRP in eight. GFRs were estimated through postoperative day 4 using the Cockcroft-Gault equation and compared to those of concurrent controls undergoing infrarenal AAA repair, matched 1:1 by gender, age, aneurysm size, preoperative GFR, and left renal vein management. GFR values were also evaluated and compared between groups at a mean follow-up of 29.0 ± 23.7 months. Renal dysfunction was defined as a decrease of GFR ≥20{\%}. Statistics were determined as appropriate for the variables of interest. Results: No perioperative mortality was recorded and no differences in major complication rates were observed between groups (p = 0.16). Operative time was longer in JAAA patients (154 ± 47 vs. 132 ± 41 min, p = 0.019). Mean renal ischemia time was 16.7 ± 7.7 min. Postoperatively, GFR values up to day 4 were significantly worse in JAAA patients compared to controls (p = 0.0007), with a fourfold risk of renal dysfunction at postoperative day 4 (34{\%} vs. 9{\%}, odds ratio [OR] = 4.44, 95{\%} confidence interval [CI] 1.1-18.1; p = 0.029). At univariate analysis, supraRC was found to be the only factor associated with perioperative renal dysfunction (OR = 11.3, 95{\%} CI 2.0-63.1; p = 0.003). At follow-up, two patients with supraRC died and another two required dialysis permanently. When compared to those with interRC or infrarenal clamping, patients with supraRC showed a persistent renal dysfunction at follow-up (p = 0.005). Conclusion: Elective JAAA repair with renal ischemia time ≤30 min is safe, but supraRC entails a significant perioperative and mid-term GFR reduction. In contrast, interRC provides results similar to those obtained after infrarenal AAA repair, allowing postoperative recovery of renal function to preoperative values.",
author = "Marrocco-Trischitta, {Massimiliano M.} and Germano Melissano and Andrea Kahlberg and Giuseppe Vezzoli and Giliola Calori and Roberto Chiesa",
year = "2009",
month = "11",
doi = "10.1016/j.avsg.2009.04.002",
language = "English",
volume = "23",
pages = "770--777",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - The impact of aortic clamping site on glomerular filtration rate after juxtarenal aneurysm repair

AU - Marrocco-Trischitta, Massimiliano M.

AU - Melissano, Germano

AU - Kahlberg, Andrea

AU - Vezzoli, Giuseppe

AU - Calori, Giliola

AU - Chiesa, Roberto

PY - 2009/11

Y1 - 2009/11

N2 - Background: Open repair of juxtarenal abdominal aortic aneurysms (JAAAs), which necessitates clamping above one (interrenal clamping, interRC) or both renal arteries (suprarenal clamping, supraRC), is associated with an increased risk of perioperative renal derangements. We reviewed our experience to investigate the impact of aortic clamping site during JAAA repair on peri- and postoperative glomerular filtration rate (GFR). Methods: Between January 2001 and March 2006, 32 patients (28 male, four female; mean age 70.5 ± 5.6 years) were submitted to elective open repair of JAAA. SupraRC was required in 12 patients and performed with cold renal perfusion (CRP) in five cases; interRC was required in 20 and performed with CRP in eight. GFRs were estimated through postoperative day 4 using the Cockcroft-Gault equation and compared to those of concurrent controls undergoing infrarenal AAA repair, matched 1:1 by gender, age, aneurysm size, preoperative GFR, and left renal vein management. GFR values were also evaluated and compared between groups at a mean follow-up of 29.0 ± 23.7 months. Renal dysfunction was defined as a decrease of GFR ≥20%. Statistics were determined as appropriate for the variables of interest. Results: No perioperative mortality was recorded and no differences in major complication rates were observed between groups (p = 0.16). Operative time was longer in JAAA patients (154 ± 47 vs. 132 ± 41 min, p = 0.019). Mean renal ischemia time was 16.7 ± 7.7 min. Postoperatively, GFR values up to day 4 were significantly worse in JAAA patients compared to controls (p = 0.0007), with a fourfold risk of renal dysfunction at postoperative day 4 (34% vs. 9%, odds ratio [OR] = 4.44, 95% confidence interval [CI] 1.1-18.1; p = 0.029). At univariate analysis, supraRC was found to be the only factor associated with perioperative renal dysfunction (OR = 11.3, 95% CI 2.0-63.1; p = 0.003). At follow-up, two patients with supraRC died and another two required dialysis permanently. When compared to those with interRC or infrarenal clamping, patients with supraRC showed a persistent renal dysfunction at follow-up (p = 0.005). Conclusion: Elective JAAA repair with renal ischemia time ≤30 min is safe, but supraRC entails a significant perioperative and mid-term GFR reduction. In contrast, interRC provides results similar to those obtained after infrarenal AAA repair, allowing postoperative recovery of renal function to preoperative values.

AB - Background: Open repair of juxtarenal abdominal aortic aneurysms (JAAAs), which necessitates clamping above one (interrenal clamping, interRC) or both renal arteries (suprarenal clamping, supraRC), is associated with an increased risk of perioperative renal derangements. We reviewed our experience to investigate the impact of aortic clamping site during JAAA repair on peri- and postoperative glomerular filtration rate (GFR). Methods: Between January 2001 and March 2006, 32 patients (28 male, four female; mean age 70.5 ± 5.6 years) were submitted to elective open repair of JAAA. SupraRC was required in 12 patients and performed with cold renal perfusion (CRP) in five cases; interRC was required in 20 and performed with CRP in eight. GFRs were estimated through postoperative day 4 using the Cockcroft-Gault equation and compared to those of concurrent controls undergoing infrarenal AAA repair, matched 1:1 by gender, age, aneurysm size, preoperative GFR, and left renal vein management. GFR values were also evaluated and compared between groups at a mean follow-up of 29.0 ± 23.7 months. Renal dysfunction was defined as a decrease of GFR ≥20%. Statistics were determined as appropriate for the variables of interest. Results: No perioperative mortality was recorded and no differences in major complication rates were observed between groups (p = 0.16). Operative time was longer in JAAA patients (154 ± 47 vs. 132 ± 41 min, p = 0.019). Mean renal ischemia time was 16.7 ± 7.7 min. Postoperatively, GFR values up to day 4 were significantly worse in JAAA patients compared to controls (p = 0.0007), with a fourfold risk of renal dysfunction at postoperative day 4 (34% vs. 9%, odds ratio [OR] = 4.44, 95% confidence interval [CI] 1.1-18.1; p = 0.029). At univariate analysis, supraRC was found to be the only factor associated with perioperative renal dysfunction (OR = 11.3, 95% CI 2.0-63.1; p = 0.003). At follow-up, two patients with supraRC died and another two required dialysis permanently. When compared to those with interRC or infrarenal clamping, patients with supraRC showed a persistent renal dysfunction at follow-up (p = 0.005). Conclusion: Elective JAAA repair with renal ischemia time ≤30 min is safe, but supraRC entails a significant perioperative and mid-term GFR reduction. In contrast, interRC provides results similar to those obtained after infrarenal AAA repair, allowing postoperative recovery of renal function to preoperative values.

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U2 - 10.1016/j.avsg.2009.04.002

DO - 10.1016/j.avsg.2009.04.002

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VL - 23

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JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

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