Factors Responsible for Acute Tubular Necrosis Following Lower Aortic Surgery

Abstract

ACUTE TUBULAR NECROSIS is one of the most serious complications following lower aortic surgery. In some patients there is only transitory oliguria and mild elevation of the blood urea nitrogen, whereas others progress to anuria and die with uremia. The widespread application of aortoiliac reconstructive surgery for arteriosclerotic aneurysms and occlusive vascular disease necessitates a knowledge of the factors responsible for, and a means of, preventing this potentially fatal complication. Although the true incidence is difficult to determine, a review of 1,659 cases from 10 different series revealed an over-all incidence of 3.8 per cent, with a range up to 20 per cent. Patients with surgical lesions of the aorto-iliac region have a high incidence of arteriosclerotic heart disease, hypertension, renal disease,¹ and genitourinary problems² which can and do compromise renal functions. Large and ruptured aneurysms may necessitate wide perirenal dissection and multiple transfusions, resulting in a period