Juxtarenal aortic aneurysms: aspects of treatment and reduction of postoperative complications

Objectives. Surgical treatment of JAAs (juxtarenal aortic aneurysms) requires suprarenal aortic cross-clamping, causing temporary renal artery occlusion. To safeguard postoperative renal function, we implemented a standardized protocol of hypothermic renal perfusion for all elective JAA operations. Design. Retrospective study. Materials and Methods. In a period of 6 years, 23 consecutive patients received a saline bolus of 4°C (300 mL) and subsequent perfusion at ±20 mL/minute in each kidney during suprarenal aortic clamping. End points were rise in serum creatinine level, new onset of dialysis and mortality. Results. None of the patients suffered from postoperative acute renal failure and in-hospital mortality was zero. Five patients did not show any rise in serum creatinine level, whereas in the others rises were <25% in comparison with the admission level, except for one patient (38%). Postoperative rise in serum creatinine level was not related to renal ischemia time (Spearman rank correlation = 0.24, p = 0.27), preoperative renal function, total aortic clamping time or renal re-implantation. Patient records at 6 months showed no renal complications. Conclusions. Our results suggest that a standardized strategy to apply renal hypothermia during the ischemic period of elective JAA surgery may prevent postoperative renal failure. This holds even in patients with preoperative renal insufficiency or renal ischemia times >50 minutes.