Renal protection by intermittent cold crystalloid perfusion during thoracoabdominal aortic aneurysm repair

Renal dysfunction is a major postoperative complication of thoracoabdominal aortic aneurysm repair and is closely associated with increased mortality. We adopted a simple method involving intermittent cold crystalloid perfusion into the renal arteries using gravity infusion during thoracoabdominal aortic aneurysm repair and evaluated its effectiveness.

Between April 2011 and January 2024, 63 patients underwent open thoracoabdominal aortic aneurysm repair at Fukuoka University Hospital. After excluding 11 cases, 52 cases were retrospectively analyzed. Intermittent renal perfusion was performed using 4 °C lactated Ringer solution containing mannitol and methylprednisolone. Patients were classified into chronic kidney disease (< 45 mL/min) and non-chronic kidney disease groups (≥ 45 mL/min) based on the preoperative estimated glomerular filtration rate, and renal function was assessed.

There were no significant differences in operative or ischemic parameters between the groups. Postoperative acute kidney injury (Kidney Disease: Improving Global Outcomes stage ≥ 2) occurred in 21% of all patients, with no significant difference between the groups. Serum creatinine levels increased transiently postoperatively in both groups but returned to baseline or improved at discharge. No patient required long-term dialysis. Urine output tended to be higher in the chronic kidney disease group than in the non-chronic kidney disease group, particularly during the early postoperative period.

Intermittent cold crystalloid perfusion is a simple and effective method for renal protection in thoracoabdominal aortic aneurysm repair with favorable clinical outcomes regardless of preoperative renal function. The absence of permanent dialysis cases suggests that this approach is safe and feasible, particularly in emergencies and resource-limited settings.