P-007 - LEFT RENAL VEIN DIVISION WITHOUT RECONSTRUCTION CAN BE SAFELY EMPLOYED DURING JUXTARENAL ABDOMINAL AORTIC ANEURYSM REPAIR

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Ramachandran Nair H. (Sree Chitra Tirunal Institute for Medical Sciences and Technology ~ Thiruvananthapuram ~ India) , Pitchai S. (Sree Chitra Tirunal Institute for Medical Sciences and Technology ~ Thiruvananthapuram ~ India) , Ramachandran S. (Sree Chitra Tirunal Institute for Medical Sciences and Technology ~ Thiruvananthapuram ~ India) , Madathipat U. (Sree Chitra Tirunal Institute for Medical Sciences and Technology ~ Thiruvananthapuram ~ India)
Introduction:
To evaluate the safety of left renal vein division (LRVD) on immediate and long-term post-operative renal function following juxtarenal abdominal aortic aneurysm (AAA) repair and compare the same with those patients with intact left renal vein.
Methods:
A single centre prospective non-randomised study done during the period January 2011 to January 2020. A total of 56 elective juxtarenal AAA repairs were performed out of which 36 patients required LRVD while 20 had their LRV intact (LRVI). Pre and post-operative renal functions were compared and also with respect to different aortic cross-clamp positions (inter-renal, suprarenal, supracoeliac). Mortality and other complications also were analysed.
Results:
In LRVD group, 1 patient (2.8%) developed immediate acute renal shut down caused due to Right renal artery occlusion which was managed by renal artery stenting leading to improvement in renal function. Perioperative renal dysfunction was noted in 19 patients (52.8%) Mean preoperative Creatinine clearance (Cr Cl) was 66.25±12.4 & at discharge was Cr Cl 63.3± 13.9 and the difference was not statistically significant (p>0.05). There was no statistical difference between the level of clamp and post op renal function (supra renal vs inter-renal vs infrarenal clamp) within LRVD group. 2 patients who had CKD at the time of surgery went on to continue renal replacement therapy in the follow up period. Majority of patients had normal renal parameters at discharge and follow up (mean of 18 months). In control group (non LRVD) 5 patients developed renal dysfunction (25%) of which 1patient had pre op chronic kidney disease and required temporary dialysis. Renal parameters reached baseline in all except one patients before discharge. Mortality was 11.1% (4 patients) in LRVD group and 10% (2 patients) in LRVI group.
Conclusion:
Left renal vein can be safely divided when mandated for safe and optimal exposure of the aorta during juxtarenal AAA repair. Routine reconstruction of the vein is not necessary and the aortic cross-clamp does not bear statistically significant effect on long term renal function.
References:
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