Abdominal Aortic Aneurysm Treatments Requiring Suprarenal Abdominal Aortic Cross-clamping

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  • 腎動脈遮断を要する腹部大動脈瘤手術

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Abstract

Introduction: Open repair requiring suprarenal aortic cross-clamping is still the treatment of choice for juxtarenal aortic aneurysms (JAA), despite advances in endovascular aneurysm repair. We assessed rates of mortality and acute kidney injury after open repair for abdominal aortic aneurysm (AAA) requiring suprarenal abdominal aortic cross-clamping in our institution. Materials and Methods: We encountered 56 patients with suprarenal AAA and JAA and infrarenal AAA requiring suprarenal abdominal aortic cross-clamping between 1996 and 2010. We retrospectively reviewed 48 elective patients, excluding 6 who received hemodialysis and 4 cases of rupture. A total of 46 patients, comprising 42 men and 6 women with an average age of 70 ± 8 years were the subjects of this study. Surgically, the suprarenal aorta was exposed after the left renal vein (LRV) was mobilized or divided. Renal preservation was accomplished by the administration of mannitol (0.5 g/kg) before suprarenal aortic cross-clamping and the administration of 4°C cold Ringer solutions in cases of RA cross-clamping of over 30 minutes. A 6-mm ePTFE graft was anastomosed to a Y-graft body prior to end-to-end aorta-to-Y graft anastomosis, and then the RA was reconstructed when necessary. Results: There were 21 patients who had LV division and 14 patients (3 bilateral, 11 one-side) with renal artery reconstruction. The renal artery clamp time was 49 ± 14 and 30 ± 17 min in cases of renal artery reconstruction and no reconstruction, respectively. There were 5 patients with postoperative acute kidney injury (increase in sCr of ≥ 0.3 mg/dl or increase to ≥ 150%–200% from baseline). And there were 2 cases of in-hospital mortality due to cardiac failure and perforation of sigmoid colon cancer. Conclusion: The cause of the renal dysfunction was considered to be embolism, and therefore in future, the possibility of a mural thrombus at the site of the aortic cross-clamp should be determined before cross-clamping. However, open repair of non-ruptured JAA requiring suprarenal abdominal aortic cross-clamping was performed with acceptable results in the current procedures for the preservation of renal function.

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