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

Abstract

Objective: Chronic renal insufficiency may be a relative contraindication to endovascular aneurysm repair (EVAR) for the use of contrast enhanced mediums. It is thought that more contrast enhanced media are needed in patients who are not anatomically suitable for EVAR, because of procedural difficulties. We reviewed a 2 year EVAR experience at our institution to determine whether the procedure and use of contrast enhanced mediums has any deleterious effect on renal function in patients with pre-existing chronic renal insufficiency. Materials and Methods: EVAR was performed in 46 patients with pre-existing chronic renal insufficiency without hemodialysis. Patients were retrospectively assigned to two groups on the basis of their preoperative creatinine clearance levels. Furthermore, patients were assigned to two other groups on the basis of anatomical suitability for EVAR. The absolute change in the serum creatinine (Cr) level was reviewed in the each renal insufficiency group between the preoperative and post-operative time periods. Results: No increase in the serum Cr level was noted, and no patient required temporary or permanent hemodialysis, in any of the groups. Conclusions: EVAR with contrast agents can be accomplished in patients with chronic renal insufficiency without hemodialysis; therefore,elevated Cr levels maynot be a contraindication in EVAR.

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

“…These results are in line with the literature data [41] and show that ''EVAR with contrast agents can be accomplished in patients with chronic renal insufficiency without hemodialysis; therefore, elevated creatinine levels may not be a contraindication in EVAR'' [41].…”

Low mortality rates after endovascular aortic repair expand use to high-risk patients

“…These findings confirm conclusions of previous reports suggesting that elevated creatinine concentration and dialysis increase mortality risk disproportionate to respiratory and cardiac comorbidities. 5,13,14 Elevated creatinine concentration alone, however, conferred a slightly increased risk of 30-day mortality compared with dialysis in our multivariate regression model (OR, 3.36 vs 2.22). In examining the contribution of multiple comorbidities to mortality risk, renal and respiratory comorbidities in combination increased 30-day mortality risk by more than sevenfold.…”

“…Several studies have attempted to evaluate the effects of single risk factors that contribute to mortality after EVAR. 5,13,14,17 Given low mortality rates after EVAR, most previous studies have found small, statistically insignificant differences between high-risk and low-risk patients. A retrospective study by Mehta et al 13 stratified patients by serum creatinine concentration (<1.5 mg/dL, 1.5-2.0 mg/dL, and 2.1-3.5 mg/dL).…”

“…Subsequent studies have detected small increases in mortality for patients with high-risk comorbidities but lack statistical power to detect differences between patients assigned to low-and highrisk groups. 11,13,14 Thus, more strongly powered data sets are needed to understand the impact of individual risk factors on the outcomes of high-risk patients after EVAR.…”

Aortic Aneurysm in Hemodialysis Patients: A Report of Two Cases

“…The most common found data concerns kidney complication after operations for AA in patients whose kidneys preoperatively were normal or were slightly altered. Here the post operative incidence of kidney failure for AA is 5.4% in patients with a normal kidney function; this incidence is multiplied by 2 or 3 amongst patients with a pre existing CKF (10)(11)(12). Mortality after kidney complication due to AA operation is very high and 25% to 66% (10-12).…”