Kidney protection in thoracoabdominal aortic aneurysm surgery

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Vascular Surgery

Background:

• Acute kidney injury (AKI) is a frequent complication following open and endovascular repair of thoracoabdominal aortic aneurysms (TAAA).
• Existing definitions for AKI vary, and proposed standardized criteria (RIFLE, AKIN, KDIGO) are not consistently applied.
• AKI significantly increases in-hospital and long-term mortality, contributes to renal function decline, and is associated with perioperative spinal cord ischemia.

Purpose of the Study:

• To review current understanding and management strategies for preventing acute kidney injury (AKI) in patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair.
• To evaluate the efficacy of various intraoperative and postoperative measures in mitigating AKI risk.
• To highlight advancements in both open and endovascular TAAA repair techniques aimed at renal protection.

Main Methods:

• Review of literature on AKI prevention in TAAA repair, encompassing both open and endovascular approaches.
• Analysis of intraoperative techniques, pharmacological interventions, and organ protection strategies.
• Discussion of imaging modalities and device design considerations relevant to renal preservation.

Main Results:

• No specific pharmacological agent has proven highly effective for AKI prevention; avoiding nephrotoxins and maintaining adequate mean arterial pressure (MAP) are crucial.
• For open TAAA repair, cold crystalloid solutions and potentially Custodiol® perfusion show promise for preventing ischemia-reperfusion injury.
• Endovascular TAAA repair may reduce AKI through techniques like fusion imaging, diluted contrast, and CO2 angiography; precise endograft design is vital for visceral vessel patency.

Conclusions:

• Preventing AKI in TAAA repair requires a multifaceted approach, emphasizing hemodynamic stability and avoidance of nephrotoxic agents.
• Innovative techniques in both open and endovascular surgery, including specialized perfusion solutions and advanced imaging, offer potential for improved renal outcomes.
• Tailoring surgical techniques and device selection to individual patient anatomy is critical for long-term renal function preservation after TAAA repair.