Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome

Toya, Naoki; Ohki, Takao; Momokawa, Yasutake; Shukuzawa, Kota; Fukushima, Soichiro; Tachihara, Hiromasa; Akiba, Tadashi

doi:10.1007/s00595-016-1324-6

Cited by 8 publications

(10 citation statements)

References 33 publications

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“…Other reported intraoperative or postoperative risk factors included intraoperative hypotension (<mean arterial pressure of 60 mmHg), postoperative low cardiac index (<2.4 L/min/m 2 ), 16 ) and postoperative vasopressor requirement. 7 ) As reported previously, 7 , 9 ) contrast material volume was not associated with postoperative AKI following EVAR.…”

Section: Discussionsupporting

confidence: 65%

“…Acute kidney injury (AKI) is a known postoperative complication of both OAR and EVAR. Postoperative AKI is associated with not only early mortality 3 – 5 ) but also survival, 4 , 6 , 7 ) cardiovascular events, 8 ) and aneurysm-related death 9 ) in the late follow-up period. Although EVAR may decrease the risk of AKI, 3 , 5 , 10 – 14 ) the reported incidence rates of AKI widely range from 12.4% to 36.2% for elective OAR 4 , 5 , 11 , 15 , 16 ) and 2.9% to 18.8% for elective EVAR.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Acute Kidney Injury Following Elective Open and Endovascular Aortic Repair for Abdominal Aortic Aneurysm

Nonaka

Kimura

Hori

et al. 2018

Annals of Vascular Diseases

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Objective: To investigate the predictors of acute kidney injury (AKI) following surgery for abdominal aortic aneurysm.Materials and Methods: Subjects were 642 non-hemodialysis patients (open aortic repair [OAR] group, n=453; endovascular aortic repair [EVAR] group, n=189) who underwent elective surgery between 2009 and 2015. AKI was assessed according to the Kidney Disease Improving Global Outcomes criteria. In-hospital mortality and incidence of AKI were compared between the OAR and EVAR groups. The effect of AKI on outcomes and predictors of AKI were examined in both groups.Results: In-hospital mortalities were 0.7% (3/453) in the OAR group and 0.5% (1/189) in the EVAR group. The incidence of AKI increased in the OAR group (14.1% vs. 3.7%, P<0.01). In the OAR group, in-hospital mortality (0% vs. 4.7%, P<0.01) increased in patients with AKI. In the OAR group, hemoglobin level <10 g/dL, estimated glomerular filtration rate <60 mL/min/1.73 m2, operation time >300 min, history of ischemic heart disease, and amount of bleeding >1,000 mL were predictors of AKI. In the EVAR group, amount of transfusion>1,000 mL was a predictor of AKI, but AKI was not found to worsen outcomes.Conclusion: AKI affected outcomes of OAR. Knowledge of predictors may optimize perioperative care.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Predictors of Acute Kidney Injury Following Elective Open and Endovascular Aortic Repair for Abdominal Aortic Aneurysm

Nonaka

Kimura

Hori

et al. 2018

Annals of Vascular Diseases

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“…However, there are conflicting studies that suggested the safety of RAAS during EVAR. 22,23 Yet, those studies were reflecting single-institutional experience with relatively small sample size and might be underpowered to detect a significant difference.…”

Section: Discussionmentioning

confidence: 99%

“…This is in line with previous studies that showed an association between preoperative renal impairment and the risk of postoperative renal dysfunction. 1,23,24 Therefore, we sought to specifically examine the risk added by RAAS in patients with prior kidney disease. Compared with patients of normal baseline kidney function who did not undergo concurrent RAAS, the risk of 30-day ARF in patients with prior kidney disease is 3-fold higher, and in patients with prior kidney disease and RAAS, there is a 12-fold increase.…”

Section: Discussionmentioning

confidence: 99%

Concurrent renal artery stent during endovascular infrarenal aortic aneurysm repair confers higher risk for 30-day acute renal failure

Nejim

Arhuidese

Rizwan

et al. 2017

Journal of Vascular Surgery

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Objective Concurrent renal artery angioplasty and stenting (RAAS) during endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysm (AAA) has been practiced in an attempt to maintain renal perfusion. The aim of this study was to identify the current practice of RAAS during EVAR and its effect on perioperative renal outcome. Methods Patients with infrarenal AAA were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP, 2011-2014) database. Baseline characteristics of patients with concurrent RAAS during EVAR were compared with those of patients who underwent EVAR only. Bivariate and multivariable logistic regression analyses controlling for patients’ demographics, comorbidities, and operative factors were used to evaluate the predictors of 30-day acute renal failure (ARF). Sensitivity analysis was done to evaluate the role of RAAS in patients with prior kidney disease. Results Overall, 6183 patients underwent EVAR for infrarenal AAA during the study period. Of them, 281 patients had RAAS during EVAR (4.5%). The median age of the patients was 74 years; 81.7% of the cohort was male, but a higher proportion of female patients received EVAR + RAAS compared with patients who underwent EVAR only (26.3% vs 17.9%; P < .001). There was no difference between groups in terms of comorbidities, being on dialysis, or functional status, yet the EVAR + RAAS group had a higher proportion of patients with glomerular filtration rate <60 mL/min/1.73 m2 (45.2% vs 37.2%; P = .011). RAAS was associated with significantly higher odds for development of ARF (adjusted odds ratio [aOR], 4.27; 95% confidence interval [CI], 2.06-8.84; P < .001). Other highly predictive factors of 30-day ARF were glomerular filtration rate <60 (aOR, 2.92; 95% CI, 1.47-5.78; P = .002), emergency status (aOR, 2.97; 95% CI, 1.21-7.27; P = .017), and ruptured AAA as the indication for EVAR (aOR, 4.74; 95% CI, 1.80-12.50; P = .002). Patients with prior kidney disease who had EVAR + RAAS demonstrated a 12-fold higher odds for 30-day ARF (aOR, 12.37; 95% CI, 4.66-32.89; P < .001). Conclusions Concurrent RAAS was found to be a significant determinant of adverse renal outcomes after EVAR for infrarenal AAA. This effect was present even after controlling for patients’ risk factors that might contribute to postoperative ARF.

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“…Having lower perioperative mortality and morbidity than conventional surgical repair, EVAR has recently become the first-line treatment of AAA [1]. However, EVAR entails various risks, including vascular injury, endoleaks, device malfunction, and embolic complications.…”

Section: Introductionmentioning

confidence: 99%

Successful Endovascular Aortic Repair (EVAR) for an Abdominal Aortic Aneurysm with a Shaggy Aorta Using a Temporary Filtered Aorto-Venous Shunt for Protection against Shower Embolism

Takebayashi

Shuto

Wada

et al. 2017

Interventional Radiology

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Endovascular aortic repair (EVAR) is generally considered to be contraindicated in the presence of a shaggy aorta, because of the high risk of shower embolization. However, many patients who have abdominal aortic aneurysms (AAAs) with diffuse aortic atherosclerosis need EVAR because of high surgical risk. We report a case of AAA with massive aortic plaques that was treated with EVAR, using an extracorporeal shunt with a blood filter constructed from the femoral artery and vein during the procedure. The patient had an uneventful postoperative course. This method of sieving emboli in a filter in an external shunt is highly effective for EVAR of a shaggy aorta.

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Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome

Abstract: Patients with postoperative CKD progression have an increased frequency of aneurysm-related death. The presence of a shaggy aorta, absence of oral beta-blocker administration and an increased preoperative creatinine level are independent predictors of early postoperative CKD progression.

Cited by 8 publications

References 33 publications

Predictors of Acute Kidney Injury Following Elective Open and Endovascular Aortic Repair for Abdominal Aortic Aneurysm

Predictors of Acute Kidney Injury Following Elective Open and Endovascular Aortic Repair for Abdominal Aortic Aneurysm

Concurrent renal artery stent during endovascular infrarenal aortic aneurysm repair confers higher risk for 30-day acute renal failure

Successful Endovascular Aortic Repair (EVAR) for an Abdominal Aortic Aneurysm with a Shaggy Aorta Using a Temporary Filtered Aorto-Venous Shunt for Protection against Shower Embolism

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