Prevention of renal insufficiency after abdominal aortic aneurysm resection by optimal volume loading.

A retrospective case review of 34 men was undertaken to evaluate the relationship between preoperative volume loading and renal function before, during, and after abdominal aortic aneurysm surgery. Volume expansion was guided by either central venous pressure (CVP) in 12 patients or pulmonary artery wedge pressure (PAWP) measurements in 22 patients. Statistically significant differences (P less than .05) were noted between the two groups where greater preoperative volume loading and urine output were associated with lower postoperative serum creatinine and renal function indices in the PAWP group. The age range, vascular risk factors, aneurysm size, and preoperative renal function were similar. The data indicate that (1) PAWP is a more accurate monitor for volume expansion than CVP and (2) when volume replacement is optimal, abdominal aortic aneurysm surgery is not associated with postoperative renal insufficiency.