Histidine-tryptophan-ketoglutarate (Custodiol® HTK) solution for renal protection during open thoracoabdominal aortic aneurysm repair: A two-stage perfusion technique

This study outlines a technique for selective kidney perfusion using histidine-tryptophan-ketoglutarate (Custodiol® HTK) solution during open thoracoabdominal aortic aneurysm repair to mitigate acute kidney injury resulting from renal ischemia. This proposed approach features a two-stage perfusion process - initial bolus followed by continuous perfusion - delivered via a simplified gravitational flow system. This low-pressure infusion system encompasses several theoretical key advantages, including reduced risk of renal edema and fluid overload, improved patient safety, and enhanced surgical outcomes. Furthermore, compared to traditional techniques (i.e., active infusion), it may prove effective in optimizing renal perfusion during complex open aortic surgeries. In this study, we present a step-by-step description of the two-stage technique for Custodiol® HTK administration.