Evolution of renal function in abdominal aortic aneurysm surgery with suprarenal cross-clamping

Objective: To analyse the effects of suprarenal cross-clamping (SC) as opposed to the infrarenal position (IC) in the evolution of the renal function abdominal aorta aneurysm (AAA) surgery. Material and method: A retrospective cohort study of AAAs treated by elective open surgery between 1998 and 2011. The preoperative level of serum creatinine (mg/dL) was determined and compared to postoperative level at 24, 48, 72 and 96 hours, and on discharge. A deterioration in the renal function was defined as a creatinine > 2 mg/dL in patients with a normal baseline creatinine level or an increase of double the baseline creatinine in patients with a previous chronic renal insufficiency (CRI). A deterioration of the glomerular filtrate (GF) was defined as a > 25% decrease. Multivariable analysis was performed on the evolution of the renal function. Results: A total of 464 AAA's were analysed, 359 (77.4%) with IC, and 105 (22.6%) with SC. The prevalence of preoperative CRI was similar in both groups. The type of clamp was not associated with a deterioration in the renal function (SC = 8.6% vs. IC = 5.7%; p =.13) but was associated with a deterioration of the GF (SC = 27.6% vs. IC = 13.4%; p =.001). The time the clamp was in place, the blood loss, and the preoperative CRI were independent risk factors for the deterioration of the renal function. The type of clamp increased the risk of deterioration of the renal function beyond 30 minutes (p =.001), being independently associated with a deterioration in the GF (OR2.04; 95% CI: 0.94-4.47). Conclusion: With SC less than 30 min, in patients with a creatinine level, a deterioration in the renal function is not foreseeable. With prior CRI, or if a prolonged SC is foreseen, a deterioration in the renal function can be expected, thereby making it necessary to evaluate methods for renal protection. (C) 2012 SEACV. Published by Elsevier Espana, S.L. All rights reserved.