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Home > Vascular Annual Meeting > RR33. Postoperative Creatinine Reduction...

RR33. Postoperative Creatinine Reduction with Non-Ischemic Femoral Arterial Cannulation for Thoracoabdominal Aortic Repair

Charles C. Miller, III, Anthony L. Estrera, Ali Azizzadeh, Sheila M. Coogan, Hazim J. Safi
University of Texas Medical School Houston, Houston, TX

OBJECTIVES: Renal failure after thoracoabdominal aortic (TAAA) repair is a significant clinical problem. Distal aortic perfusion for organ and spinal cord protection requires cannulation of the left femoral artery. In 2006 we discovered that direct cannulation led to leg ischemia in some patients, and that this was associated with increased renal failure. Following this finding, we modified our perfusion technique to eliminate leg ischemia from cannulation. Here we present the effects of this change on postoperative renal function.

METHODS: Between February 1991 and July 2008, we repaired 1443 TAAA, 1067 using distal aortic perfusion, and only those receiving distal perfusion were studied. Median age was 68 years and 373/1067 (35%) were female. In September 2006 we adopted a sidearm femoral cannulation technique that provides distal aortic perfusion while maintaining downstream flow to the leg. This was used in 135 (12%) patients. We measured the joint effects of preoperative glomerular filtration rate (GFR) and cannulation technique on highest postoperative creatinine. Analysis was by multiple linear regression with interaction and log transformation of creatinine.

RESULTS: Median postoperative creatinine was 1.6 mg/dl, with an interquartile range of 1.0 - 3.4. The highest observed postoperative creatinine was 12.3. Although crude mean postoperative creatinine did not differ between the direct and sidearm cannulation groups, a strong interaction with preoperative GFR was present. Regression model terms were GFR x -0.006 (p<0.0001), sidearm x -0.27 (p<0.02) and GFR x sidearm x 0.004 (p<0.0001). For preoperative GFR below 70, sidearm cannulation was associated with an approximate 50% reduction in peak postoperative creatinine.

CONCLUSIONS: Use of sidearm cannulation is associated with a clinically important and highly statistically significant reduction in postoperative creatinine in patients with low GFR. Reduced renal effect of skeletal muscle ischemia is the proposed mechanism.

AUTHOR DISCLOSURES: C.C. Miller, None; A.L. Estrera, None; A. Azizzadeh, None; S.M. Coogan, None; H.J. Safi, None.