Abstract
A 73-year-old man with a history of hypertension and drug-induced hepatitis underwent surgical treatment of an enlarging pararenal abdominal aortic aneurysm (PRAAA) with bilateral renal artery stenosis, found on enhanced computed tomography (CT). His preoperative renal function was normal. We divided the right renal artery and used a 6-mm expanded polytetrafluoroethylene (ePTFE) tube graft for the anastomosis. Renal artery perfusion was achieved by a rapid infusion pump set at 200 ml/min. The left renal artery was reconstructed and perfused in the same way. The abdominal aorta was cross-clamped just distal to the superior mesenteric artery and a Y-graft was anastomosed. The ePTFE grafts were connected to the Y-graft and bilateral renal artery circulation was re-established. The renal ischemic time was 1 h 25 min and the urine output during reconstruction was 80 ml. Postoperatively, his serum blood urea nitrogen and serum creatinine levels increased slightly, but normalized within 3 days. This case report shows that this method of renal artery perfusion could prove useful for complex renal artery reconstructions.
Similar content being viewed by others
References
Allen BT, Anderson CB, Rubin BG, Flye MW, Baumann DS, Sicard GA. Preservation of renal function in juxtarenal and suprarenal abdominal aortic aneurysm repair. J Vasc Surg 1993;17:948–959.
Jean-Claude JM, Reilly LM, Stoney RJ, Messina LM. Pararenal aortic aneurysm: the future of open aortic aneurysm repair. J Vasc Surg 1999;29:902–912.
Wahlberg E, DiMuzio PJ, Stoney RJ. Aortic clamping during elective operations for infrarenal disease: the influence of clamping time on renal function. J Vasc Surg 2002;36:13–18.
Johnston KW. Multicenter prospective study of non-ruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality. J Vasc Surg 1989;9:437–447.
Powell RJ, Roddy SP, Meier GH, Gusberg RJ, Conte MS, Sumio BE. Effect of renal insufficiency on outcome following infrarenal aortic surgery. Am J Surg 1997;174:126–130.
Crawford ES, Beekett WC, Greer MS. Juxtarenal infrarenal abdominal aortic aneurysm. special diagnostic and therapeutic considerations. Ann Surg 1986;203:661–670.
Breckwoldt WL, Mackey WC, Belkin M, O’Donnell TF Jr. The effect of suprarenal cross-clamping on abdominal aortic aneurysm repair. Arch Surg 1992;127:520–524.
Kudo FA, Nishibe T, Miyazaki K, Murashita T, Yaduda K, Ando M, et al. Postoperative renal function after elective abdominal aortic aneurysm repair requiring suprarenal aortic cross-clamping. Surg Today 2004;34:1010–1013.
Zierler RE, Bergein RO, Issacson JA, Strandness DE Jr. Natural history of atherosclerotic renal artery stenosis: a prospective study with duplex ultrasonography. J Vasc Surg 1991;19:250–258.
Tollefson DFJ, Ernst CB. Natural history of atherosclerotic renal artery stenosis associated with aortic disease. J Vasc Surg 1991;14:327–331.
Hassen-Khodja R, Sala F, Declemy S, Bouillane PJ, Batt M. Renal artery revascularization in combination with infrarenal aortic reconstruction. Ann Vasc Surg 2000;14:577–582.
Taylor SM, Langan EM 3rd, Snyder BA. Concomitant renal revascularization with aortic surgery: are the risks of combined procedures justified? Am Surg 2000;66:768–772.
Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. J Vasc Surg 1992;16:378–390.
Stoney RJ, Skioldebrand CG, Ovarfordt PG, Reilly LM, Ehrenfeld WK. Juxtarenal aortic atherosclesosis: surgical experience and functional result. Ann Surg 1984;2000:345–354.
Ochesner JL, Mills NL, Gardner PA. A technique for renal preservation during suprarenal abdominal aortic operations. Surg Gynecol Obstet 1984:159;388–390.
Furukawa K, Nakamura K, Yano M, Yano Y, Matsuyama M, Kojima K, et al. Protection of renal function by cold Ringer’s solution perfusion in abdominal aortic aneurysm surgery requiring suprarenal aortic cross-clamping (in Japanese with English abstract). Jpn J Vasc Surg 2006;15:435–440.
Nypaver TJ, Shepard ADM, Reddy DJ, Elliott JP Jr, Smith RF, Ernst CB. Repair of pararenal abdominal aortic aneurysms. Arch Surg 1993;128:803–813.
Brewster DC, Davison JK, Ballantyne K. Renal perfusion during complex aortic reconstruction: Use of a radial-renal shunt. Surgery 1981;90:823–827.
Maeda H, Negishi N, Shiono M, Ishii Y, Niino S, Kohno H, et al. Procedure for preservation of visceral and renal function in suprarenal and juxtarenal abdominal aortic aneurysm repair (in Japanese with English abstract). Jpn J Vasc Surg 2000;9:689–693.
Tandan V, Panos A, Houck J, Salerno TA. Renal perfusion with the biomedicus pump during resection of an abdominal aortic aneurysm. Can J Surg 1992;35:634–636.
Sugiki H, Siiya N, Matsuzaki K, Tachibana T, Kudou AF, Yasuda K. A case report of juxtarenal aneurysm of the abdominal aorta which needed a supraceliac clamp and renal perfusion (in Japanese with English abstract). Jpn J Vasc Surg 2003;12:617–620.
Shindo S, Kojima A, Iyori K, Ishimoto T, Kobayashi M, Suzuki O, et al. Abdominal aortic aneurysm repair with arterial branch reconstruction: utility of the temporary bypass technique. Surg Today 1998:28:498–502.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aoki, A., Sangawa, K. Repair of a pararenal abdominal aortic aneurysm with bilateral renal artery stenosis using a rapid infusion pump for renal perfusion: Report Of a case. Surg Today 38, 751–755 (2008). https://doi.org/10.1007/s00595-007-3693-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-007-3693-3