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This proposed approach features a two-stage perfusion process \u2013 initial bolus followed by continuous perfusion \u2013 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\u00ae HTK administration.<\/jats:p>","DOI":"10.1177\/02676591251374634","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T10:38:23Z","timestamp":1758278303000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Histidine-tryptophan-ketoglutarate (Custodiol\u00ae HTK) solution for renal protection during open thoracoabdominal aortic aneurysm repair: A two-stage perfusion technique"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4270-0243","authenticated-orcid":false,"given":"Nicola","family":"Colangelo","sequence":"first","affiliation":[{"name":"Extracorporeal Circulation Unit, IRCCS San Raffaele Hospital, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Aina","sequence":"additional","affiliation":[{"name":"Extracorporeal Circulation Unit, IRCCS San Raffaele Hospital, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"De Simone","sequence":"additional","affiliation":[{"name":"Extracorporeal Circulation Unit, IRCCS San Raffaele Hospital, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Gallio","sequence":"additional","affiliation":[{"name":"Extracorporeal Circulation Unit, IRCCS San Raffaele Hospital, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6313-9160","authenticated-orcid":false,"given":"Jacopo","family":"D\u2019Andria Ursoleo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margherita","family":"Licheri","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaia","family":"Barucco","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5186-1976","authenticated-orcid":false,"given":"Fabrizio","family":"Monaco","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.08.048"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.09.055"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001432"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.11.077"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2016.03.031"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(89)90435-7"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.06.072"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.03.020"},{"key":"e_1_3_4_10_2","first-page":"P31","article-title":"Perfusion techniques for renal protection during thoracoabdominal aortic surgery","volume":"44","author":"Bhamidipati CM","year":"2012","unstructured":"Bhamidipati CM, Coselli JS, LeMaire SA. 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