Purpose: Renal failure remains a common and morbid complication after
complex aortic surgery. This study was performed to identify periopera
tive factors that contribute to postoperative renal failure. Methods:
The perioperative outcomes of 183 patients who underwent thoracoabdomi
nal aortic surgery with supraceliac clamping were reviewed. During the
interval from Tan. 1987 to Nov. 1996, thoracoabdominal aneurysm repai
r was performed in 154 patients (type I, 49 patients [27%]; type II, 2
1 patients [11.5%]; type III, 55 patients [30%]; type TV, 29 patients
[16%]), suprarenal abdominal aortic aneurysm repair in 17 patients (9%
), and visceral/renal revascularization procedures in 12 patients (6.5
%). Intraoperative management included thoracoabdominal aortic exposur
e and clamp-and-sew technique with renal artery cold perfusion wheneve
r the renal arteries were accessible (79% of cases). Results: Relevant
clinical features included preoperative hypertension (85%), diabetes
mellitus (8%), single functioning kidney (10%), recent intravenous con
trast injection (34%), renal insufficiency (creatinine level greater t
han 1.5 mg/dl; 24%), and emergent operation (19%). Acute renal failure
, defined as both a doubling of serum creatinine level and an absolute
value greater than 3.0 mg/dl, occurred in 21 patients (11.5%), of who
m five required hemodialysis (2.7%). Variables associated with this co
mplication included a preoperative creatinine level greater than 1.5 m
g/dl (p = 0.004) and a total cross-clamp time greater than 100 minutes
(p = 0.035). The operative mortality risk (within 30 days; 8%) was si
gnificantly increased with renal failure (odds ratio, 9.2; 95% confide
nce interval, 2.6 to 33; p < 0.005). Conclusions: Renal failure, altho
ugh uncommon in contemporary practice, greatly increases the risk of e
arly death after thoracoabdominal aortic surgery. The overall incidenc
e of renal failure and dialysis requirement in the present series comp
are favorably with those reported using other operative techniques, sp
ecifically partial left heart bypass and distal aortic perfusion. Thes
e data suggest that patients who have preoperative renal insufficiency
are prone to postoperative renal failure. Furthermore, regional hypot
hermic perfusion and minimal clamp times are important elements in the
prevention of renal failure after thoracoabdominal aortic surgery.