The Impact of Endovascular Repair of Ruptured Abdominal Aortic Aneurysm on the Gastrointestinal and Renal Function

Abstract

Introduction. Systemic effects of ruptured abdominal aortic aneurysm (rAAA) may be altered by the mode of surgery. This study aimed to determine systemic effects of endovascular aneurysm repair (EVAR) compared to open repair (OR). Patients and Methods. Consecutive patients with rAAA were repaired by OR or EVAR according to computerised tomographic (CT) findings. Renal function was monitored by estimated glomerular filtration rate (eGFR), serum urea and creatinine, and urinary albumin creatinine ratio (ACR). Hepatic function was assessed postoperatively for 5 days. Intestinal function was determined by the paracetamol absorption test. Intestinal permeability was assessed by urinary lactulose/mannitol ratio. Results. 30 rAAA patients were included. Fourteen had eEVAR and sixteen eOR. Serum urea were higher in eOR, while creatinine was similar between groups. Hepatic function showed no intergroup difference. Paracetamol absorption was increased in eEVAR group at day 3 compared to day 1 (P = 0.03), with no similar result in eOR (P = 0.24). Peak lactulose/mannitol ratio was higher in eOR (P = 0.03), with higher urinary L/M ratio in eOR at day 3 (P = 0.02). Clinical intestinal function returned quicker in eEVAR (P = 0.02). Conclusion. EVAR attenuated the organ dysfunction compared to open repair. However, a larger comparative trial would be required to validate this. The clinical trial is registered with reference number EUDRACT: 2013-003373-12.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

“…Emergency EVAR also carries the risk of several complications like those encountered after OSR. Whether EVAR is superior to OSR in terms of major morbidity remains to be seen, 455 however, a recent analysis of the Vascular Quality Initiative (2003e 2013) database (514 EVAR, 651 OSR) suggested that EVAR is associated with lower in hospital morbidity than OSR. 456 Specifically, the incidence of cardiac complications (EVAR, 29% vs. OSR, 38%; p ¼ 0.001), respiratory complications (28% vs. 46%; p < 0.0001), renal insufficiency (24% vs. 38%; p < 0.0001), lower extremity ischaemia (2.7% vs. 8.1%; p < 0.0001), and bowel ischaemia (3.9% vs. 10%; p < 0.0001) were significantly lower after EVAR than after OSR.…”

Initial experience of follow up of patients after the endovascular treatment of abdominal aortic aneurysms using contrast-enhanced ultrasound

“…U pacientů indikovaných k léčbě AAA je vždy riziko zhoršení renálních funkcí v souvislosti se zákrokem. Toto riziko je vlastní oběma metodám léčby -chirurgické i endovaskulární [10,11]. Řada studií srovnávala výsledky obou metod se zaměřením na pooperační zhoršení renálních funkcí.…”

Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review

“…Indeed evidence is emerging that the inflammatory response to RAAA repair and the associated organ dysfunction is attenuated by eEVAR compared with open repair. 31 32 …”