Comparison of the impact of open and endovascular abdominal aortic aneurysm repair on renal function

Saratzis, Athanasios; Sarafidis, Pantelis A.; Melas, Nikolaos; Khaira, H.S.

doi:10.1016/j.jvs.2014.03.282

Cited by 41 publications

(30 citation statements)

References 38 publications

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“…Overall, immediate post-operative renal injury, using absolute SCr drop within 48 hours, has a lower incidence post-EVAR compared to open-repair in most historical series, 32 whereas at least 3 studies (2 of which defined "AKI" as SCr rise> 50% and one as >30% compared to baseline) have shown increased incidence following EVAR (estimated at about 18%) than open repair (ranging from 5% to 15%). 4,6,28,[33][34][35] The introduction and evolution of contemporary criteria for AKI definition [Risk Injury Failure Loss End-stage (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO)] 36 has provided a uniform basis for research efforts in the field and led to conduction of several relevant studies. Table 1 summarizes findings of studies reporting AKI incidence after elective EVAR, using contemporary AKI reporting criteria.…”

Section: Introductionmentioning

confidence: 99%

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

Jhaveri

Saratzis

Wanchoo

et al. 2017

Kidney International

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Section: Introductionmentioning

confidence: 99%

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

Jhaveri

Saratzis

Wanchoo

et al. 2017

Kidney International

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“…Elective treatment in the form of open (OAR) or endovascular (EVAR) repair is advocated in those with an AAA of more than 5.5cm in diameter (30). Both OAR and EVAR can lead to significant renal insults (31). We have previously shown that almost 20% of patients undergoing elective EVAR will develop AKI and that is associated with impaired short and long-term outcomes (1,4,14).…”

Section: Introductionmentioning

confidence: 99%

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Saratzis

Shakespeare

Jones

et al. 2017

European Journal of Vascular and Endovascular Surgery

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What this paper addsThe impact of cardiovascular reserve on acute kidney injury (AKI) after endovascular surgery remains unclear, mostly due to the difficulties in assessing cardiovascular reserve. We are still unsure whether AKI is related mostly to pre-existing occult co-morbidities, such as cardiovascular disease, or procedure-related parameters. Hence, developing an adequate renoprotective strategy is not an easy task. In this analysis, we have shown that development of AKI after intervention is associated with pre-operative cardiovascular reserve, independent of other risk-factors and procedural parameters. This offers insight in what drives AKI development after endovascular intervention and where/how preventative measures should focus.

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“…The current prevalence of AAA for men above the age of 65 ranges from 2 to 7%, and elective treatment in the form of open or endovascular repair (OAR or EVAR) is advocated when the AAA-diameter reaches 5.5 cm [8] . Both OAR and EVAR can lead to significant insults to the kidney, such as hypovolaemia, ischaemia-reperfusion injury, and contrast nephropathy [7,9] . EVAR is associated with better short-term results compared to OAR; however, this benefit is not sustained after the third postoperative year [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular Outcomes

et al. 2015

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Background: Acute kidney injury (AKI) has been associated with all-cause short- and long-term mortality. However, its association with cardiovascular (CV) events remains unclear. We sought to investigate this in patients undergoing open (OAR) or endovascular (EVAR) abdominal aortic aneurysm repair, as they are likely to develop both AKI and CV morbidity. A meta-analysis was subsequently performed to confirm this in other CV-interventions. Methods: AKI-incidence was assessed in a multicentre-cohort of 1,068 patients undergoing EVAR (947 individuals) or OAR electively using the ‘Acute Kidney Injury Network' criteria. A composite-endpoint was used, consisting of non-fatal myocardial infarction (MI), stroke, vascular event, hospitalisation due to heart failure and CV death. A systematic literature review identified studies reporting AKI-incidence and CV events. Risk ratios (RRs) at 1 and 5 years were combined using meta-analysis. Results: During a median follow-up of 62 months (range 11-121), AKI was associated with CV events on adjusted (for CV risk-factors) analyses (Incidence 36% of EVAR, 32% of OAR patients; hazard ratio 1.73, 95% CI 1.06-3.39, p = 0.03) for the overall population. In the meta-analysis, 7 studies reported incidence of MI on 23,936 patients 1-year after coronary intervention (PCI) with a pooled RR of 1.76 (95% CI 1.45-2.83, p < 0.001); at 2 years, 3 studies reported MI incidence on 17,773 patients after PCI with a pooled RR of 1.34 (95% CI 1.10-1.63, p = 0.003). MI-incidence was reported 5 years after cardiac surgery by 3 studies (33,701 patients) with a pooled RR of 1.60 (95% CI 1.43-1.81). Conclusion: AKI is associated with long-term CV events after surgery or endovascular intervention.

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Comparison of the impact of open and endovascular abdominal aortic aneurysm repair on renal function

Abstract: OR and suprarenal fixation EVAR are associated with significant declines in renal function during 2 years, in contrast to infrarenal EVAR fixation. The patterns of eGFR decline in OR and suprarenal fixation EVAR are not similar, suggesting different causal mechanisms.

Cited by 41 publications

References 38 publications

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular Outcomes

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