Supracoeliac vs Infrarenal Clamp — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaSupracoeliac vs Infrarenal ClampFRCA Final

A 68-year-old man (ASA III) undergoes an open AAA repair. Intraoperatively the surgeon applies a supracoeliac aortic clamp. Compared to an infrarenal clamp, what additional organ is at significant risk of ischaemia?

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Correct answer: E — Kidneys and liver

A supracoeliac (suprarenal) aortic clamp occludes blood flow to the coeliac trunk (supplying the liver, spleen, stomach) and the renal arteries (supplying the kidneys), in addition to the organs at risk from infrarenal clamping (lower limbs, pelvic organs, spinal cord). This causes: significantly greater afterload increase (SVR increases by 50-100%), renal ischaemia (AKI risk), hepatic ischaemia, mesenteric ischaemia, and more severe metabolic acidosis on unclamping. Management: minimise supracoeliac clamp time, give mannitol before clamping, titrate vasodilators carefully, and monitor urine output and lactate closely.

Reference: RCOA – 2023 – Vascular anaesthesia module; NICE – 2020 – AAA management