Patients requiring concomitant renal artery reconstruction were excluded from this review. Suprarenal cross-clamp was used in 51 patients with temporary vessel-loop control of the renal arteries. Creatinine (Cr) and glomerular filtration rates (eGFR) were
measured pre-, post-, and long-term after surgery. Outpatient records of all patients that had survived more than 12 months were also reviewed in order to evaluate the late effects on renal function or symptoms possibly related to LRVDAL.
Results. Median procedure duration was 157 (61-375) minutes. Median cross-clamp time was 16 (10-45) minutes. Median intensive care unit (ICU) and hospital length TGF-beta inhibitor of stays were 2 (1-11) days and 7 (4-58) days, respectively. There were no deaths. There were no complications directly related to renal vein ligation. Hematuria, seen in 2 patients, was a result
PP2 of traumatic insertion of a Foley catheter. Median pre-op and discharge Cr levels were 1.1 mg/dL (0.7-2.4 mg/dL) and 1.1 mg/dL (0.6-2.1 mg/dL), respectively (P < .5). Median change in Cr was 0.0 mg/dL and only increased in 14 patients (maximum increase 0.9 mg/dL). Median pre-op and discharge eGFR was 61 mL/minute (28-137 mL/minute/1.73 m2) and 67 mL/minute (32-138 mL/minute/1.73 m2), respectively (P < .5). Cr and eGFR in the 2 patients with a Cr of >2.0 mg/dL remained unchanged post-op. Only 2 patients with a Cr of <2.0 mg/dL had a post-op Cr >2.0 mg/dL and both returned to normal by day 3 post-op. Thirty-six patients have been followed for more than a year (median 34.5 months, maximum 144 months) and Cr has remained stable in all but 2 patients. These 2 patients, both with a pre-op Cr of 1.5 mg/dL, subsequently
developed Cr levels of 2.1 mg/dL and 2.4 mg/dL but maintained baseline Cr levels for 25 and 34 months, respectively, before demonstrating these elevated levels which have proven to be unrelated to renal vein ligation. Hematuria and flank pain have see more never been recorded after discharge.
Conclusion: Restoration of left renal vein continuity after LRVDAL may be unnecessary since renal compromise and hematuria was not encountered in this long-term analysis. (J Vasc Surg 2009;50:500-4.)”
“OBJECTIVE:The subtemporal approach for a superficial temporal artery-to-superior cerebellar artery bypass requires significant superior retraction that can injure the temporal lobe, compromise veins, and cause edema postoperatively. In contrast, the pretemporal approach requires posterolateral retraction that seems to be less injurious to the temporal lobe and better tolerated clinically. We hypothesized that the pretemporal approach provides ample exposure, more gentle retraction, and better clinical results than the subtemporal approach.
METHODS: Standard orbitozygomatic-pterional and subtemporal approaches were performed on both sides of 4 formalin-fixed cadaver heads for morphometric measurements.