Morbidity and Mortality Associated with Renal Insufficiency and Endovascular Repair of Abdominal Aortic Aneurysms: A 5-Year Experience

Abstract

To evaluate the outcome of patients with renal insufficiency undergoing endovascular repair of abdominal aortic aneurysm (AAA), data were prospectively collected between 1998 and 2003 on patients undergoing elective repair of their AAA with a stent graft. The patients were divided into 2 groups: those with serum creatinine (Crs) concentrations <1.2 (Group A) and those with Crs > or =1.2 mg/dL not requiring hemodialysis (Group B). The outcomes of the procedure for these 2 groups were compared. Different variables that existed between the 2 groups and contributed to mortality included estimated blood loss (EBL), volume of contrast used in the operating room, incidence of diabetes (DM), tobacco use, and history of myocardial infarction (MI). In total, 213 patients underwent elective repair of their AAA with use of a stent graft: 61% who had a Crs <1.2 mg/dL (Group A) and 39% who had a Crs > or =1.2 mg/dL not requiring dialysis (Group B). Among 129 patients with normal renal function there was an 18.6% complication rate and 1.6% mortality rate. Of 83 patients with renal insufficiency not on hemodialysis 30.1% (Fisher's Exact Test = 0.076) had 1 or more complications and there was a 6% (Fisher's Exact Test = 0.166) mortality rate. One patient in Group A (0.8%) progressed to hemodialysis and 5 (6%) patients in Group B progressed to end-stage renal disease requiring hemodialysis (p=0.068). A statistically significant higher proportion of the patients in Group B had a history of MI (p<0.001). There was no difference in the amount of EBL between the 2 groups, but a significantly lower amount of contrast (p<0.05) was used in patients with renal insufficiency.

Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate

“…16,18,19 ; (6) can EVAR be done safely in patients with pre-existing renal impairment? 11,[31][32][33][34] ; and (7) does baseline renal insufficiency increase perioperative and long-term morbidity and mortality? 8 Nearly all published studies of the effect of EVAR on renal function are limited by short follow-up, lack of open control groups, variable definitions of postoperative renal dysfunction, use of serum creatinine level (SCr) instead of creatinine clearance (CrCl) or glomerular filtration rates (GFR) as a measure of renal function, and a multitude of other confounding variables.…”

Chronic kidney disease and postoperative mortality: A systematic review and meta-analysis

“…The methodological quality of each study is shown in Table 2. Of the 31 studies, 13 collected data prospectively 11,12,[15][16][17][18][19][20][21][22][23] whereas 18 used retrospective data from health records. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Two studies used variables such as age, sex, cardiovascular risk factors, and surgical risk, to match patients with normal kidney function to those with chronic kidney disease.…”

Can Laboratory Tests Predict the Prognosis of Patients after Endovascular Aneurysm Repair? Current Status and Future Directions

“…26 General complication rates were also found to be higher in patients with preoperative renal insufficiency (30.1%) versus patients with normal preoperative renal function (18.6%). 32 A high creatinine level appeared to be an important risk factor for mortality in our study of patients. The underlying pathologic mechanism is, however, not completely understood.…”

“…Whereas our meta-analysis demonstrated that serum creatinine levels correlate relatively well to perioperative mortality in mostly elective repair, studies of ruptured AAA showed less consistent results. [29][30][31][32] Anain and colleagues showed that preoperative creatinine using a cutoff value of 1.5 mg/dL was associated with increased risk of 30-day mortality, although this was not significant. 31 Acosta and colleagues and Sharif and colleagues found that preoperative creatinine using a cutoff of 2.15 mg/dL was no significant predictor of in-hospital mortality.…”