Renal function after elective infrarenal aortic aneurysm repair in patients with pelvic kidneys

Area of Science:

• Vascular Surgery
• Nephrology
• Transplantation

Background:

• Pelvic kidneys present unique challenges during abdominal aortic aneurysm repair due to increased risk of renal ischemia.
• Standard renal protection strategies include shunting, cooling, and collateral perfusion.

Purpose of the Study:

• To evaluate the effectiveness of different renal protection strategies in patients with pelvic kidneys undergoing elective abdominal aortic aneurysm repair.
• To compare outcomes between congenital and transplanted pelvic kidneys.

Main Methods:

• A review of patients with congenital (non-solitary) and transplanted pelvic kidneys undergoing elective abdominal aortic aneurysm repair.
• Analysis of renal protection methods: topical cooling, no preservation, aortorenal shunting, and endovascular repair.
• Comparison of preoperative and postoperative creatinine levels.

Main Results:

• Congenital pelvic kidneys showed no significant postoperative creatinine elevation with topical cooling or collateral perfusion.
• Transplanted pelvic kidneys treated with endovascular repair had no creatinine increase.
• Open repair of transplanted pelvic kidneys resulted in transient creatinine elevation.
• Intraoperative shunting in transplanted pelvic kidneys led to creatinine normalization.

Conclusions:

• Aortorenal shunting and endovascular repair effectively preserve renal function in transplanted pelvic kidney patients.
• For congenital pelvic kidneys, cooling and collateral perfusion are generally adequate.
• Endovascular repair appears superior to open repair for minimizing renal ischemia in pelvic kidney patients, though data is limited.