Temporary Axillorenal Bypass in Complex Aorto-Renal Surgery

Area of Science:

• Vascular Surgery
• Nephrology
• Surgical Innovation

Background:

• Prolonged renal ischemia during vascular surgery is associated with significant morbidity and mortality.
• Maintaining renal circulation during suprarenal aortic or renal artery clamping presents a surgical challenge.
• Existing methods for managing renal ischemia during complex aortic procedures have limitations.

Purpose of the Study:

• To evaluate the efficacy of a temporary axillorenal bypass technique.
• To assess the impact of this bypass on renal ischemia time during aorto-renal surgery.
• To determine the safety and effectiveness of the technique in high-risk patients.

Main Methods:

• A cohort of 16 patients undergoing aorto-renal surgery between 2007 and 2012 utilized temporary axillorenal bypass.
• Procedures included suprarenal aortic aneurysms, occlusive disease, renal artery stenoses, and tumors.
• Preoperative risk factors and intraoperative variables were compared with postoperative renal function and mortality outcomes.

Main Results:

• Median renal ischemia time was 24.5 minutes (range 8-50 minutes).
• Transient acute renal dysfunction occurred in 38% of patients, with 4 having preoperative renal insufficiency.
• Only one patient (6%) required transient renal replacement therapy, and 30-day mortality was zero.

Conclusions:

• Temporary axillorenal bypass is a valuable strategy for reducing renal ischemia time in high-risk vascular surgery.
• The technique demonstrated excellent safety and effectiveness, with improved or baseline renal function at 1-month follow-up.
• This approach offers a considerable option for preserving renal function during complex aortic and renal artery interventions.