A comparison of renal function between open and endovascular aneurysm repair in patients with baseline chronic renal insufficiency

Abstract

Open and endovascular repair of abdominal aortic aneurysms in patients with pre-existent renal insufficiency can be performed safely with preservation of renal function. In contrast to previous reports, no significant differences existed between open repair and EVAR in postoperative alterations in renal function. Although a significant increase in serum creatinine develops in patients with renal insufficiency postoperatively with open repair, this appears to be transient, and preoperative renal dysfunction alone should not exclude either approach. After EVAR, patients with pre-existing renal insufficiency continue to be at risk for progressive renal dysfunction, and protective measures should be taken to preserve renal function in this patient population.

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

“…17) Acute renal failure requiring hemodialysis has been reported to complicate the course of 0.5% to 2% of patients undergoing elective AAA repair, with associated in-hospital mortality ranging from 25% to 66%. 15,[18][19][20][21][22][23][24][25][26] Contrary to that report, our findings demonstrated that at 7 day after the operation, the incidence of a 10% or greater increase in serum Cr over the preoperative level was 10.9%, which was significantly lower in comparison to the previous report. Anatomical suitability for EVAR aortic neck diameter of 18-28 mm, neck length ≥15 mm, neck angulation <60, iliac diameter of 7.5-20 mm, length of iliac sealing zone ≥10 mm Fig.…”

The outcome of thoracic endovascular aortic repair (TEVAR) in patients with renal insufficiency

“…Greenberg et al 25 similarly showed a decrement in renal function 12 months postoperatively, although this effect was transient. Parmer et al 26 evaluated the effect of EVAR on patients with chronic renal insufficiency, and although the differences were not statistically significant, there was a similar decrease in renal function over time. 6 TEVAR, however, differs from EVAR in many respects, which may explain why renal function was preserved in this study.…”

Renal outcomes analysis after endovascular and open aortic aneurysm repair

“…The use of unadjusted serum creatinine levels as a marker for renal injury varies: in some cases, renal impairment is defined as a transient or permanent increase in serum creatinine concentration >1.5 mg/dL 5,8,11,12,18 ; in others, it is defined as an increase of 20%, 19 25%, 4 or 30% 2,20 from baseline levels. Consequently, most series now report the eGFR, calculated with various formulas, such as the MDRD study equation, as a more sensitive test for renal functioning and impairment.…”