Medical Journal of The Islamic Republic of Iran (MJIRI)

 Abstract

 Background: Renal insufficiency is a potential complication after infrarenal abdominal aortic aneurysm repair and is a significant risk factor for postoperative mortality and morbidity. The aim of this study was to analyze the effect of this risk factor, before and during operation.

 Methods: In this prospective study, between 2003 and 2006, 45 patients underwent repair of an infrarenal abdominal aortic aneurysm. Elective surgical repair was performed in 34 patients and 11 patients underwent immediate surgical repair of ruptured aneurysms. There were 41 males and 4 females. The mean age was 68 years. The patients were divided into four groups depending on their preoperative serum creatinine (Scr), group I, serum creatinine less than 1.4 mg/dl, group II 1.4 < Scr< 2 mg/dl, group III 2 < Scr<2.5 mg/dl and group IV Scr >2.5 mg/dl. In each group postoperative changes in renal function were analyzed.

 Results: Several factors significantly influenced postoperative serum creatinine concentration and BUN level. These factors were: previous renal disease (diabetic nephropathy and renal artery stenosis), ruptured aneurysm and profound shock, blood transfusion greater than 4 units, duration of clamping time (greater than 2 hrs and 10 min), and age over 65 years. The postoperative rise in serum creatinine level was noted in 33 patients (73.3%) and BUN increased in 27 cases (60%), but only 2 patients out of these 33 patients required hemodialysis. Renal function recovery occurred after several days of surgery (3 to 5 days).

 Conclusion: The cause of renal dysfunction after elective or emergency repair of an infrarenal abdominal aortic aneurysm is multifactorial and the most important predictor is preoperative renal insufficiency, so special precautions are appropriate in such patients for prevention of this complication. Decreasing the aortic clamp time, operative time and blood loss, and administration of optimal volume loading seems to be essential.