PURPOSE: @entity177 remains a common and morbid complication after complex aortic surgery. This study was performed to identify perioperative factors that contribute to @entity177 . METHODS: The perioperative outcomes of 183 @entity1 who underwent thoracoabdominal aortic surgery with supraceliac clamping were reviewed. During the interval from Jan. 1987 to Nov. 1996, thoracoabdominal @entity439 repair was performed in 154 @entity1 (type I, 49 @entity1 [27%]; type II, 21 @entity1 [11.5%]; type III, 55 @entity1 [30%]; type IV, 29 @entity1 [16%]), suprarenal @entity1028 repair in 17 @entity1 (9%), and visceral/renal revascularization procedures in 12 @entity1 (6.5%). Intraoperative management included thoracoabdominal aortic exposure and clamp-and-sew technique with renal artery cold perfusion whenever the renal arteries were accessible (79% of cases). RESULTS: Relevant clinical features included preoperative @entity101 (85%), @entity6 (8%), single functioning kidney (10%), recent intravenous contrast injection (34%), @entity177 ( @entity1011 level greater than 1.5 mg/dl; 24%), and emergent operation (19%). @entity810 , defined as both a doubling of serum @entity1011 level and an absolute value greater than 3.0 mg/dl, occurred in 21 @entity1 (11.5%), of whom five required hemodialysis (2.7%). Variables associated with this complication included a preoperative @entity1011 level greater than 1.5 mg/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 significantly increased with @entity177 (odds ratio, 9.2; 95% confidence interval, 2.6 to 33; p < 0.005). CONCLUSIONS: @entity177 , although uncommon in contemporary practice, greatly increases the risk of @entity204 after thoracoabdominal aortic surgery. The overall incidence of @entity177 and dialysis requirement in the present series compare favorably with those reported using other operative techniques, specifically partial left heart bypass and distal aortic perfusion. These data suggest that @entity1 who have preoperative @entity177 are prone to @entity177 . Furthermore, regional hypothermic perfusion and minimal clamp times are important elements in the prevention of @entity177 after thoracoabdominal aortic surgery.

XXXX after thoracoabdominal aortic surgery.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes mellitus'] @entity177 :: ('MESH:D051437', 'Disease') :: ['renal insufficiency', 'renal failure', 'postoperative renal failure', 'Renal failure'] @entity439 :: ('MESH:D000783', 'Disease') :: ['aneurysm'] @entity810 :: ('MESH:D058186', 'Disease') :: ['Acute renal failure'] @entity1011 :: ('MESH:D003404', 'Chemical') :: ['creatinine'] @entity204 :: ('MESH:D003643', 'Disease') :: ['early death'] @entity1028 :: ('MESH:D017544', 'Disease') :: ['abdominal aortic aneurysm']
@entity177 :: (MESH:D051437,Disease) :: ['Renal failure']
