F-EVAR does not Impair Renal Function more than Open Surgery for Juxtarenal Aortic Aneurysms: Single Centre Results

Shahverdyan, Robert; Majd, M.P.; Thul, R.; Braun, Niko; Gawenda, M.; Brunkwall, Jan

doi:10.1016/j.ejvs.2015.04.028

Cited by 45 publications

(25 citation statements)

References 27 publications

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“…reported the incidence of KDIGO-defined AKI following suprarenal clamping to be 26.5% (n=34). 23) To the best of our knowledge, our study is the second to analyze KDIGO-defined AKI that occurs after suprarenal clamping. We also investigated the efficacy of our HRP technique, i.e., bolus administration of a hypothermic renal protection solution.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Yokoyama

Nonaka

Kimura

et al. 2020

Annals of Vascular Diseases

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Objective: To investigate predictors of acute kidney injury (AKI) following open aortic repair (OAR) requiring suprarenal clamping. Methods: The study included 833 nonhemodialysis patients who had undergone elective OAR (with suprarenal clamping, n=73; with infrarenal clamping, n=760). We evaluated AKI as defined by the criteria of the Kidney Disease Improving Global Outcomes (KDIGO) and compared in-hospital outcomes between the two groups. We also investigated the effects of AKI on outcomes, factors related to post-suprarenal clamping AKI, and efficacy of hypothermic renal perfusion (HRP) in the suprarenal clamping group. Results: For the suprarenal vs. infrarenal clamping group, in-hospital mortality was 0% (0/73) vs. 0.5% (4/760). The incidence of AKI was greater in the suprarenal clamping group (37% vs. 15%, P<0.001), and the hospital stay for patients with AKI was longer than for those patients without AKI (median, 21 days vs. 16 days; P=0.005). Renal ischemia time and bleeding volume >1,000 mL were associated with post-suprarenal clamping AKI. Renal ischemia time was longer with HRP (n=15) than without HRP (n=58) (median, 51 min vs. 33 min; P=0.011), and HRP did not decrease the incidence of AKI (40% vs. 36%; P=0.78). Conclusion: Prolonged renal ischemia and substantial intraoperative bleeding are associated with postoperative AKI following suprarenal clamping.

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Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Yokoyama

Nonaka

Kimura

et al. 2020

Annals of Vascular Diseases

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“…36 In the setting of aneurysm repair, renal impairment has been associated with worsening renal function postoperatively, as well as increased operative and long term mortality for both open and endovascular repair. 30,31,[37][38][39] Renal artery stenosis and occlusive disease was associated with worsening renal function, but in the setting of F/B-EVAR the impact of this disease process is not fully understood and may potentially have a multifactorial effect, adversely influencing renal branches in combination with functional impairment.…”

Section: Discussionmentioning

confidence: 99%

Survival affects decision making for fenestrated and branched endovascular aortic repair

Beach

Rajeswaran

Parodi

et al. 2018

Journal of Vascular Surgery

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Patients with multiple comorbidities and those undergoing type I or II TAAA repair are at greatest risk of mortality; however, in this high-risk population, F/B-EVAR offers greater survival compared with that reported for the natural history of untreated aneurysms. Operative and early mortality is lower than the best-reported open repair outcomes, even in this high-risk population, suggesting a potential benefit in extending the use of F/B-EVAR to low-to-average risk CAA patients.

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“…Both fenestrated and chimney techniques using EVAR are attractive options for P/JAAA treatment, with encouraging early and mid-term outcomes; however, compared with open repair, there are some problems regarding higher rates of secondary reintervention and renal impairment during follow-up [21] [22].…”

Section: Discussionmentioning

confidence: 99%

Significance of Cold Renal Perfusion on Renal Function and Clinical Outcomes When Renal Ischemia Time Exceeded 30 Min during Pararenal and Juxtarenal Abdominal Aortic Aneurysm Surgery

Furukawa¹,

Mori²,

Shirasaki³

et al. 2019

WJCS

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Objectives: To investigate the influence of cold renal perfusion on renal function and clinical outcomes in cases where the renal ischemia time exceeded 30 min during pararenal and juxtarenal abdominal aortic aneurysm (P/JAAA) surgery. Methods and Results: Fifty-four patients who underwent open repair for P/JAAAs were retrospectively analyzed. Thirty-nine patients received renal perfusion with cold Ringer's solution (perfusion group) and 15 patients did not receive renal perfusion (non-perfusion group). There were no significant differences in preoperative serum creatinine level (Cr) (1.08 ± 0.42 vs. 1.35 ± 0.71 mg/dL, p = 0.09), percentage of patients with Cr > 2 mg/dL [2/38 (5%) vs. 2/15 (13%), p = 0.8], and renal ischemia time during proximal aortic clamping (49 ± 21 vs. 47 ± 11 min; p = 0.8) between the groups. Postoperative Cr was significantly lower in the perfusion group than in the non-perfusion group (1.48 ± 0.76 vs. 2.23 ± 1.21 mg/dL, p < 0.01). The percentage of patients with postoperative Cr > 2 mg/dL was also significantly lower in the perfusion group than in the non-perfusion group [5 (13%) vs. 7 (47%), p < 0.01)]. At discharge, Cr returned to preoperative levels in both groups. All patients were discharged from the hospital without incidents. Conclusion: Renal artery perfusion with cold Ringer's solution clearly reduced the deterioration of postoperative renal function compared to non-renal perfusion.

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F-EVAR does not Impair Renal Function more than Open Surgery for Juxtarenal Aortic Aneurysms: Single Centre Results

Abstract: This retrospective analysis demonstrates that OSR might be combined with more acute post-operative renal impairment than F-EVAR for JAA, but with similar intermediate term procedure related mortality and renal outcomes.

Cited by 45 publications

References 27 publications

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Survival affects decision making for fenestrated and branched endovascular aortic repair

Significance of Cold Renal Perfusion on Renal Function and Clinical Outcomes When Renal Ischemia Time Exceeded 30 Min during Pararenal and Juxtarenal Abdominal Aortic Aneurysm Surgery

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