Prevention of acute renal failure in major vascular surgery.

The aim of this study was to analyse the main problems which involve renal function in major vascular surgery and can lead to postoperative acute renal failure. The factors responsible for renal damage in this surgical branch are at first analysed, then followed by the physiological changes which characterize the renal injury, the techniques employed to detect and monitor them and finally the therapeutic tools available to prevent acute renal failure. The most significant data of personal experience on the use of nifedipine and low-dose dopamine during abdominal aortic surgery are then presented. It is concluded that: a) an ischemic attack is the main cause of acute renal failure in mayor vascular surgery; b) prevention of ischemic renal damage is far superior to treatment; c) the optimal management of the cardiovascular function by means of the invasive hemodynamic monitoring, is the main tool to protect the kidneys and prevent acute renal failure; d) the pharmacological protection by diuretics and low-dose dopamine is of minor importance and anyway subordinate to the maintenance of adequate hemodynamics, as well as for calcium antagonist whose employment however seems to protect the kidneys better against an ischemic attack.