[Prevention of acute renal failure in suprarenal aortic surgery. Results of a pilot study]

Abstract

Acute renal failure continues to be a frequent complication after vascular operations with interruption of renal circulation. Aim of the study was to evaluate two methods to prevent postischemic renal failure after suprarenal aortic surgery: the pretreatment with Prostaglandin E1 and the organ perfusion with cold saline solution. 24 patients, who did not receive Prostaglandin E1 or cold organ perfusion were used as control (Group A). 37.5% of these patients (n = 9/24) developed acute renal failure. 3 needed hemodialysis postoperatively. Only 3 out of 26 patients (11.5%), who received PGE1 (Group B), showed deterioration of renal function with plasma creatinine values greater than 2 mg % and no patient needed dialysis. 6 out of 26 patients (23%), who received organ perfusion with cold saline (Group C), developed acute renal failure and in one case temporary hemodialysis was necessary. Plasma creatinine increased in the group A from 1.1 (0.1) mg % to 1.95 (0.4) mg % on third postoperative day and to 2.1 (0.4) mg % on discharge, while after pretreatment with PGE1 (Group B) plasma creatinine increased from 1.25 (0.1) mg % to 1.44 (0.1) mg %. In the group C creatinine increased from 1.3 (0.1) mg % to 1.77 (0.1) mg %. On discharge from the hospital plasma creatinine decreased to mean values of 1.25 (0.1) mg % in the group B and 1.5 (0.1) mg % in the group C. Intraoperative organ perfusion with cold saline and Prostaglandin E1 allows today complicated arterial reconstructions of both aorta and renal arteries with minimal risk of postischemic renal damage.