[Atheromatous embolization as a cause of postoperative renal dysfunction in infrarenal aortic reconstructive surgery]

Influences of atheromatous changes in the aortic wall at the site of proximal clamping were studied retrospectively on postoperative renal function in an infrarenal aortic reconstruction. Atheromatous lesion was evaluated on CT scan as low density layer in the aortic wall observed in cases with the thickened wall exceeding 3mm, and they were classified into atheromatous group (group II) consisted of 21 patients. In these patients, the postoperative serum creatinine showed significant elevation from preoperative value of 0.89 +/- 0.32 mg/dl to 1.67 +/- 0.90 mg/dl on 1st postoperative day (p < 0.01), 1.25 +/- 0.99 mg/dl on 7th day (p < 0.05) and 1.24 +/- 0.89 mg/dl on discharge (p < 0.05). Correlation between the severity of the postoperative renal dysfunction and the degree of the atheromatous changes evaluated by preoperative CT scan was also defined and 2 patients with severe changes died of acute renal failure. On the contrary, 39 patients without thickened wall (group I) showed no significant elevation of serum creatinine after operation. These results strongly suggest that atheromatous embolization to the kidney plays an important role to cause postoperative renal impairment following infrarenal aortic reconstructive surgery for the patients with atheromatous changes in the aorta near the site of proximal clamping.