Renal failure following abdominal aortic reconstruction.

Renal failure in aortic surgery is frequently due to the additive effects of multiple subthreshold insults that progressively decrease renal reserve. Prevention of renal failure requires a high index of suspicion concerning the clinical setting in which renal injury may occur. If cardiac hemodynamics and arterial pressure are maintained at optimal levels, especially during periods of maximum hemodynamic stress, ischemic renal injury can be minimized. This requires aggressive monitoring of cardiac hemodynamics using a Swan-Ganz (thermodilution) catheter for measurement of pulmonary artery wedge pressure and cardiac output. Prompt recognition of hemodynamic instability allows rapid intervention to correct the renal ischemia before irreversible renal injury can occur.