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Minimise renal damage in supra renal aorta X clamp (Physiological…
Minimise renal damage in supra renal aorta X clamp
AKI: Independent predictor of morbidity and mortality after AAA surgery
Preop optimisation
Patients with impending failure should be optimised with RRT
Patients at high risk who have experienced contrast induced renal dysfunction should be given time for the kidneys to recover
Physiological
Fluid balance and maintenance of normovolaemia
Use of balanced crystalloid solutions to avoid hyperchloraemic acidosis
Avoidance of synthetic colloids
Invasive monitoring to guide therapy
Avoidance of nephrotoxins e.g. NSAIDS, aminoglycosides, ACE inhibitors
Maintain O2 carrying capacity (i.e. haemoglobin)
Discussion with surgeons regarding technique
Minimise X Clamp time (strongest predictor of postop renal dysfunction)
Partial L heart bypass (LA to femoral artery/distal aorta)
Endovascular repair
Hypothermic renal perfusion
Selective renal artery perfusion
Pharmacological
Evidence is that drugs used to renoprotect do not work
Renal dose dopamine
Loop diuretics
Mannitol
Fenoldopam
Statins