Postoperative renal function after elective abdominal aortic aneurysm repair requiring suprarenal aortic cross-clamping

Purpose. To examine postoperative renal function after suprarenal aortic cross-clamping performed without renal hypothermia in patients undergoing elective abdominal aortic aneurysm (AAA) surgery. Methods. Between 1991 and 2000, 18 patients underwent surgery for a juxtarenal AAA, which required a suprarenal aortic cross-clamp. All AAAs were repaired with a proximal anastomosis just below the renal arteries. We divided the patients into two groups according to the duration of the renal ischemia: < 45min (n = 12) and >= 45 min (n = 6). The postoperative changes in renal function were analyzed. Results. There were no hospital deaths and none of the patients needed permanent hemodialysis. The postoperative peak in the serum creatinine level after suprarenal cross-clamping for >= 45 min was significantly higher than that after cross-clamping for <45 min. The percentage changes in serum creatinine and blood urea nitrogen were correlated positively with the duration of renal ischemia, and were significantly greater in the group with renal ischemia of <45 min than in the group with prolonged renal ischemia (>= 45 min). Conclusions. Suprarenal aortic cross-clamp without performing renal hypothermia is safe and able to be tolerated well by the patient during elective AAA surgery, although careful attention must be paid to limiting the period of renal ischemia.