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The value of Swan-Ganz catheterization and volume loading in preventing renal failure in patients undergoing abdominal aneurysmectomy.

A prospective analysis of 61 patients undergoing abdominal aneurysmectomy is presented. When compared with 87 historical controls we have shown that the incidence of hypotensive episodes (31 out of 62 patients in the original study compared with 13 out of 44 patients in the prospective analysis) is significantly reduced when fluid balance is monitored invasively using the pulmonary artery wedge pressure and keeping it at 10 mm H2O (p less than 0.03). Renal dysfunction, defined as a significant drop in urine output and a doubling of the serum creatinine, occurred in only 10% of patients compared with 33% in the controls (p less than 0.001). The decreased prevalence of renal failure accounts for the reduction in mortality noted (p less than 0.01). There were 27 deaths (31%) amongst the patients in the earlier study compared with 9 (15%) in the prospective analysis. The pathogenetic mechanisms responsible for the development of renal failure following surgical manipulation of the abdominal aorta are reviewed.