SESSION TYPE: Critical Care Student/Resident Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Aortic dissections commonly extend beyond the renal arteries with varying effects ranging from asymptomatic to renal failure. We report a case of aortic dissection with initial renal compromise, which was continuously monitored utilizing direct renal oximetry for evaluation of real-time renal perfusion and function.
CASE PRESENTATION: A 65 year-old female with a long history of uncontrolled hypertension presented with acute retrosternal chest pain radiating to the back for 12 hours. She was in stable condition except for a serum creatinine of 1.6mg/dl. Magnetic resonance angiography (MRA) demonstrated a type A dissection extending from the aortic root to the left common iliac artery. The only vessel originating from the false lumen was the left renal artery. The patient was emergently taken to the operating room for aortic root repair with graft. She sustained no intra-operative complications and underwent standard post-operative care. Due to initial elevation in serum creatinine and false lumen perfusion of the left kidney, FORE-SIGHT oximetry monitoring was placed on each kidney utilizing pre-operative imaging. Absolute renal tissue oxygen saturation was recorded for 3 consecutive days post-operatively. The right kidney spent a total 1858 minutes (89%) at greater than 60% saturation while the left kidney spent 1915minutes (92%) (Figure 1). Neither kidney recorded saturations below 52% and serum creatinine cleared to baseline of 1.0 mg/dl. Computed tomography (CT) angiography confirmed perfusion in both kidneys.
DISCUSSION: Distal organ perfusion can be a difficult assessment to make in the setting of aortic dissection. The laser technology utilized by FORE-SIGHT implements precise and narrow wavelengths proven to provide more accurate and absolute oxygen saturation values. By utilizing FORE-SIGHT oximetry in conjunction with imaging for precise placement, our group was able to accurately monitor renal perfusion in real time as opposed to waiting for contrast CT scan or traditional secondary markers such as serum creatinine and urine output. Saturations were maintained at expected levels throughout the post-operative course and renal function improved. This novel approach may serve a role in adjusting for renal oxygenation and subsequent perfusion in order to prevent renal failure in variety of settings from aortic injury to open cardiac procedures.
CONCLUSIONS: Renal oximetry may serve as an additional tool in evaluating, and potentially preventing, renal injury in the setting of aortic dissection.
1) Fischer W, Gregory. Recent advances in application of cerebral oximetry in adult cardiovascular surgery. Seminars in Cardiothoracic and Vascular Anesthesia. 2008;12(1):60-69.
DISCLOSURE: The following authors have nothing to disclose: Philip Batista, NIcholas Cavaricchi, Hitoshi Hirose
DIscuss the use of oximetry monitoring utilized in cerebral oxygenation and applying to a new purpose for evaluation of renal perfusionThomas Jefferson University, Philadelphia, PA