Tags

Type your tag names separated by a space and hit enter

Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair.
J Vasc Surg. 2013 Mar; 57(3):648-54.JV

Abstract

OBJECTIVE

Juxtarenal abdominal aortic aneurysms (AAAs) have predominantly been repaired using an open technique. We present a series of patients with juxtarenal AAAs and analyze multiple factors predictive of postoperative renal dysfunction.

METHODS

Between March 2000 and September 2011, all patients in our prospectively maintained database undergoing juxtarenal AAA repair were evaluated for demographics, operative details, and in-hospital outcomes. Postoperative renal dysfunction was classified using the RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria (glomerular filtration rate decrease >25%). The relationship between perioperative factors and postoperative renal dysfunction was explored using both univariate and multivariate analysis (logistic regression).

RESULTS

Of 169 patients, 76 (45%) required clamping above one renal artery, whereas 93 patients (55%) required clamping above both renal arteries. Mean (standard deviation) renal ischemia time was 29.2 (8.9) minutes (range, 12-65 minutes). Twenty-seven patients (16%) underwent adjunctive renal procedures, 19 (11.3%) required left renal vein division, and 130 (76.9%) received intraoperative mannitol. Postoperative renal dysfunction occurred in 63 patients (37.3%), with the majority (69%) resolving during hospital stay. Seven patients (4.1%) required postoperative dialysis, which was permanent in two cases. Patients who developed postoperative renal dysfunction had significantly longer mean renal ischemia times (34.7 [9.3] minutes vs 25.9 [6.6] minutes; P < .001), a higher rate of bilateral suprarenal aortic clamping (68.3% vs 47.2%; P = .008), higher rates of adjunctive renal artery procedures (26.7% vs 8.8%; P = .002), and higher rates of left renal vein division (20.6% vs 5.7%; P = .003). Logistic regression identified left renal vein division, renal ischemia time, and aortic clamp position as the strongest predictors of renal dysfunction. The use of mannitol was seen to be protective. Overall in-hospital mortality was 4.1% and was 9.5% among patients with postoperative renal dysfunction.

CONCLUSIONS

Postoperative transient renal dysfunction occurred in 37.3% of patients after open juxtarenal AAA repair, with a low incidence of dialysis and a low rate of permanent dysfunction. Technical factors including renal ischemia time, aortic clamp position, and left renal vein division are the strongest predictors of renal dysfunction. The use of intraoperative mannitol was associated with decreased postoperative renal dysfunction.

Authors+Show Affiliations

Division of Vascular Surgery, London Health Sciences Centre & Western University, London, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23312936

Citation

Dubois, Luc, et al. "Technical Factors Are Strongest Predictors of Postoperative Renal Dysfunction After Open Transperitoneal Juxtarenal Abdominal Aortic Aneurysm Repair." Journal of Vascular Surgery, vol. 57, no. 3, 2013, pp. 648-54.
Dubois L, Durant C, Harrington DM, et al. Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair. J Vasc Surg. 2013;57(3):648-54.
Dubois, L., Durant, C., Harrington, D. M., Forbes, T. L., Derose, G., & Harris, J. R. (2013). Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair. Journal of Vascular Surgery, 57(3), 648-54. https://doi.org/10.1016/j.jvs.2012.09.043
Dubois L, et al. Technical Factors Are Strongest Predictors of Postoperative Renal Dysfunction After Open Transperitoneal Juxtarenal Abdominal Aortic Aneurysm Repair. J Vasc Surg. 2013;57(3):648-54. PubMed PMID: 23312936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair. AU - Dubois,Luc, AU - Durant,Craig, AU - Harrington,David M, AU - Forbes,Thomas L, AU - Derose,Guy, AU - Harris,Jeremy R, Y1 - 2013/01/09/ PY - 2012/07/17/received PY - 2012/09/05/revised PY - 2012/09/11/accepted PY - 2013/1/15/entrez PY - 2013/1/15/pubmed PY - 2013/4/20/medline SP - 648 EP - 54 JF - Journal of vascular surgery JO - J Vasc Surg VL - 57 IS - 3 N2 - OBJECTIVE: Juxtarenal abdominal aortic aneurysms (AAAs) have predominantly been repaired using an open technique. We present a series of patients with juxtarenal AAAs and analyze multiple factors predictive of postoperative renal dysfunction. METHODS: Between March 2000 and September 2011, all patients in our prospectively maintained database undergoing juxtarenal AAA repair were evaluated for demographics, operative details, and in-hospital outcomes. Postoperative renal dysfunction was classified using the RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria (glomerular filtration rate decrease >25%). The relationship between perioperative factors and postoperative renal dysfunction was explored using both univariate and multivariate analysis (logistic regression). RESULTS: Of 169 patients, 76 (45%) required clamping above one renal artery, whereas 93 patients (55%) required clamping above both renal arteries. Mean (standard deviation) renal ischemia time was 29.2 (8.9) minutes (range, 12-65 minutes). Twenty-seven patients (16%) underwent adjunctive renal procedures, 19 (11.3%) required left renal vein division, and 130 (76.9%) received intraoperative mannitol. Postoperative renal dysfunction occurred in 63 patients (37.3%), with the majority (69%) resolving during hospital stay. Seven patients (4.1%) required postoperative dialysis, which was permanent in two cases. Patients who developed postoperative renal dysfunction had significantly longer mean renal ischemia times (34.7 [9.3] minutes vs 25.9 [6.6] minutes; P < .001), a higher rate of bilateral suprarenal aortic clamping (68.3% vs 47.2%; P = .008), higher rates of adjunctive renal artery procedures (26.7% vs 8.8%; P = .002), and higher rates of left renal vein division (20.6% vs 5.7%; P = .003). Logistic regression identified left renal vein division, renal ischemia time, and aortic clamp position as the strongest predictors of renal dysfunction. The use of mannitol was seen to be protective. Overall in-hospital mortality was 4.1% and was 9.5% among patients with postoperative renal dysfunction. CONCLUSIONS: Postoperative transient renal dysfunction occurred in 37.3% of patients after open juxtarenal AAA repair, with a low incidence of dialysis and a low rate of permanent dysfunction. Technical factors including renal ischemia time, aortic clamp position, and left renal vein division are the strongest predictors of renal dysfunction. The use of intraoperative mannitol was associated with decreased postoperative renal dysfunction. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23312936/Technical_factors_are_strongest_predictors_of_postoperative_renal_dysfunction_after_open_transperitoneal_juxtarenal_abdominal_aortic_aneurysm_repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(12)02030-7 DB - PRIME DP - Unbound Medicine ER -