Renal Function after Elective Infrarenal Aortic Aneurysm Repair in Patients with Pelvic Kidneys

The Importance of Venous and Renal Anomalies for Surgical Repair of Abdominal Aortic Aneurysms

“…In particular, the number and anatomical layout of the renal arteries should be established in advance of surgery, so that a surgical strategy for renal protection and arterial reimplantation can be formed. CT after the operation can disclose areas of renal infarction, suggesting that at least one renal artery originating from the aneurysm had been divided during the operation (Bui et al, 2007). Duplex ultrasonography provide hemodynamic information such as alterations of peak systolic velocity that can occur in cases of severe kinking or dislocation of congenital pelvic kidney renal arteries in cases of huge associated aorto-iliac aneurysms.…”

“…A preprocedure elevation of creatinine likely puts the patient at a higher risk for clinically apparent ATN postprocedure because of diminished functional renal reserve. (Bui et al, 2007). In spite of all techniques for protection the pelvic kidney during aorta reconstruction ATN is common after surgery and tends to resolve within two weeks.…”

“…The risk factors currently associated with postoperative ATN include (1) the pelvic kidney constituting all functioning renal mass (congenital solitary pelvic kidney, renal transplant); (2) more than two anastomoses required to revascularize the kidney (e. g., reimplantation or bypass of the pelvic renal artery); (3) an elevated creatinine preoperatively; (4) poor collaterals such as occluded lumbars, inferior mesenteric artery, or internal iliac arteries or a measured aortic sac backpressure of <35 mm Hg; and (5) estimated aortic cross-clamp time for more than 50 min. (Bui et al, 2007). Different mechanisms may plausibly be involved in renal function impairment, mainly related to malperfusion of congenital pelvic kidney such as aneurysm distal embolization, kinking of the renal artery, hemodynamic effects of abnormal pulsatility, and in the case of large lesions, due to depression of the renal parenchyma, renal veins, and the ureter and/or ureteropelvic junction.…”

“…In cases of iliac aneurysm, it may be needed to reimplant the renal artery. If during aortic cross-clamping an ischemic discoloration of a segment of the kidney is observed that indicates the lack of a collateral vascular supply and the necessity of reimplanting the artery that supply that segment (Bui et al, 2007). In case of renovascular hypertension refractory at treatment with an atrophic pelvic kidney it could be needed a nephrectomy for better hypertension control with less drugs (Sebe et al, 2004).…”

“…This compression of the sac could potentially lead to significant embolization. (Bui et al, 2007). When using a bifurcated graft, performing the distal before the proximal anastomosis is another described technique for limiting clamp time.…”