Influence of Chronic Renal Insufficiency on Outcomes Following Carotid Revascularization

Abstract

To examine the perioperative and longterm outcomes of patients undergoing carotid revascularization and to determine the influence moderate or severe renal insufficiency may have on these outcomes.

Carotid Revascularization in Asymptomatic Patients after Renal Transplantation

“…A number of other investigators have stratified CKD patients by creatinine or glomerular filtration rate (GFR) and shown that the incidence of postoperative complications correlates with severity of renal insufficiency. 12,13,23 Avgerinos et al examined asymptomatic patients undergoing CEA, and similar to Yuo et al found high perioperative complication rates for those with GFR <30 (stroke 10.3%, MI 10.3%), but much lower rates for those with GFR 30e59 (stroke 2.2%, MI 1.1%). Similarly, Protack et al 12 reported high rates of perioperative complications following CAS for those with more severe renal insufficiency (mortality 15.4%, stroke 23.08%, MI 7.69%), and lower rates for those with moderate CKD (mortality, stroke, MI all 3.33%).…”

“…12,13,23 Avgerinos et al examined asymptomatic patients undergoing CEA, and similar to Yuo et al found high perioperative complication rates for those with GFR <30 (stroke 10.3%, MI 10.3%), but much lower rates for those with GFR 30e59 (stroke 2.2%, MI 1.1%). Similarly, Protack et al 12 reported high rates of perioperative complications following CAS for those with more severe renal insufficiency (mortality 15.4%, stroke 23.08%, MI 7.69%), and lower rates for those with moderate CKD (mortality, stroke, MI all 3.33%). Comparing our results with these previous studies, it appears that transplant patients may fit in an intermediate risk category, with higher risk than patients with normal renal function or moderate CKD, but less than those with severe CKD or on dialysis.…”

Outcome of Gastric Cancer Surgery in Patients with Chronic Kidney Disease

“…Matsumoto et al [22] reported no significant difference in the long-term outcome between the mild CKD group and the control group. Protack et al [24] reported that the 30-day morbidity and mortality rates after carotid revascularization for patients with moderate renal insufficiency (eGFR <60 and ≥ 30 ml/ min/1.73 m 2 ) were similar to those of patients with normal renal function, while patients with severe renal insufficiency (eGFR <30 ml/min/1.73 m 2 ) had higher mortality rates. Third, most patients had not been followed for 246 more than 3 months until surgery; therefore, those who did not completely fit the definition of CKD might have existed in the CKD group, which might have contributed to making the outcome appear better.…”

Impact of Chronic Kidney Disease on Outcomes of Surgical Resection for Primary Colorectal Cancer

“…16 The majority of articles reported that maintenance dialysis was at a higher risk of postoperative complications after major surgery, including surgery on the heart, lung, spine, and abdominal aortic aneurysm, and laparoscopic cholecystectomy, [17][18][19][20][21][22] whereas there have been controversial results in carotid endarterectomy. [23][24][25][26][27] Moreover, postoperative morbidity and mortality rates were much higher in emergency abdominal surgery than elective operations in patients on hemodialysis. 28 When restricted to resection for CRC, there was only 1 English article 29 found by our extensive search.…”

“…In a recent study investigating the same type of surgery, no remarkable difference was observed in these morbidity rates among different CKD stages. 27 Meanwhile, there has been no informative report on the relationship between each cardiovascular complication rate and CKD stage after abdominal surgery. Therefore, further largescale investigation will be necessary to elucidate whether the disparity in cardiovascular complication types was associated with CKD stage or specific for colorectal surgery.…”