The Management of Abdominal Aortic Aneurysms in Patients with Concurrent Renal Impairment

Bown, Matthew J.; Norwood, M. G. A.; Sayers, Robert D.

doi:10.1016/j.ejvs.2005.02.048

Cited by 25 publications

(16 citation statements)

References 81 publications

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“…84 A recent review has also observed that while many patients with renal insufficiency will have only a transient deterioration in renal function, mortality and morbidity, including the need for more intensive postoperative organ system support, appear to be increased. 85 Surprisingly, there is little data regarding the specifics of management in patients undergoing AAA repair with chronic renal insufficiency (CRI) and whether management should be guided by serum creatinine, creatinine clearance, or glomerular filtration rate. In the perioperative period, relative or absolute changes in blood volume can cause renal injury.…”

Section: Level Of Recommendation: Strong Quality Of Evidence: Lowmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

636

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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Section: Level Of Recommendation: Strong Quality Of Evidence: Lowmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

636

520

View full text Add to dashboard Cite

show abstract

“…Although CRF develops more frequently after an aortic dissection and aortic surgery in patients with preexisting renal disease [1][2][3][4], the past medical history of this patient is unremarkable for renal insufficiency and other comorbidities associated with chronic renal injury (e.g., hypertension, diabetes, etc.). The slightly elevated creatinine level at the time of his initial admission for radiating back pain can be explained by the aortic dissection.…”

Section: Discussionmentioning

confidence: 96%

“…ARF is a common complication of aortic surgery especially when preexisting renal insufficiency or organ malperfusion is present [1][2][3][4]. After surgery, the patient initially experienced a gradual improvement in kidney function.…”

Section: Discussionmentioning

confidence: 97%

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Recovery of Renal Function in a Dialysis-Dependent Patient Following Gastric Bypass Surgery

Tafti

Haghdoost

Álvarez³

et al. 2009

OBES SURG

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There is increasing evidence that obesity, independently from other comorbidities such as diabetes and hypertension, can cause renal dysfunction. While this indolent dysfunction may be asymptomatic, it can render patients more susceptible to renal insufficiency when the kidneys are further injured by other pathological processes. Here, we present a morbidly obese patient whose type-A aortic dissection was complicated by acute renal failure that subsequently progressed into end-stage renal disease. However, his renal function improved dramatically following substantial weight reduction after gastric bypass surgery obviating the need for dialysis and transplantation. The potential mechanisms by which a patient's obesity may lead to renal dysfunction are discussed. This case and other similar reports suggest that obese patients with renal failure can safely undergo bariatric surgery and that bariatric surgery may have a role in treating chronic kidney disease in select morbidly obese patients.

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“…If preexisting cardiac disease is identified, appropriate intervention should be considered before elective EVAR. Preexisting renal insufficiency has a known association with poor EVAR outcomes (50,51). Renal status should be assessed before EVAR and renal protection strategies should be used to address any renal dysfunction.…”

Section: Indications and Contraindications For Evarmentioning

confidence: 99%

Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association

Walker

Kalva

Yeddula

et al. 2010

Journal of Vascular and Interventional Radiology

134

102

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The Management of Abdominal Aortic Aneurysms in Patients with Concurrent Renal Impairment

Cited by 25 publications

References 81 publications

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Recovery of Renal Function in a Dialysis-Dependent Patient Following Gastric Bypass Surgery

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