Validating the use of contrast-induced nephropathy prediction models in endovascular aneurysm repairs

Cheng, Evelyn Lixuan; Hong, Qiantai; Yong, Enming; Chandrasekar, Sadhana; Tan, Glenn Wei Leong; Lo, Zhiwen Joseph

doi:10.1016/j.jvs.2019.07.093

Cited by 13 publications

(12 citation statements)

References 18 publications

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“…The continued admission of patients for #72 hours to monitor their creatinine would be a large deviation from the norm and a burden on the healthcare system. Although some studies [7][8][9] have shown AKI in the early postoperative period, we found no data that showed that the presence of AKI changed the outcomes. Also, our contrast use during EVAR averaged <80 mL, which is approximately one half the dose given for preoperative computed tomography angiography and less than that for many procedures performed in office-based laboratories, for which patients do not receive hydration before or after no undergo renal monitoring for #72 hours afterward.…”

Section: Replycontrasting

confidence: 70%

“…6 External and sudden events, such as the COVID-19 (coronavirus disease 2019) pandemic, can catapult academia to adapt and evolve. 7 As conferences, teachings, and healthcare delivery turn online, social media have been paramount in disseminating scholarly information, sharing conference highlights, hosting journal clubs, and discussing best practices and novel breakthroughs. 8,9 Moreover, it has facilitated the formulation of new networks to allow for mentorship and support opportunities, especially for female trainees and faculty and other underrepresented voices in medicine and surgery.…”

Section: Advancing Academia Through Social Media: Opportunities In Vascular Surgerymentioning

confidence: 99%

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Montross

Dryjski

2021

Journal of Vascular Surgery

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Section: Replycontrasting

confidence: 70%

Section: Advancing Academia Through Social Media: Opportunities In Vascular Surgerymentioning

confidence: 99%

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Montross

Dryjski

2021

Journal of Vascular Surgery

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“…Of all the evaluated models, the Mehran score had the best discriminative ability in endovascular patients. 17…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Risk and Contrast Volume in Intact Versus Ruptured Endovascular Aneurysm Repair in the Vascular Quality Initiative

LaFontaine

Goriacko

Carnevale

et al. 2022

Vasc Endovascular Surg

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Objective Renal impairment after repair of ruptured abdominal aortic aneurysm has been associated with post-operative mortality. Acute kidney injury (AKI) risk specifically related to contrast administration in endovascular aneurysm repair (EVAR) for intact vs ruptured aneurysms has not been previously described. It was our objective to evaluate the risk of AKI and the association with contrast administration in EVAR for ruptured (rEVAR) and intact (iEVAR) aneurysm repair in the Vascular Quality Initiative (VQI). Methods Adult patients less than 90 years old undergoing EVAR in the VQI without prior abdominal aortic surgery or who were not actively on dialysis preoperatively were included. Patients immediately converted to an open repair were excluded. Patients were grouped by repair urgency, and patient and operative characteristics and outcomes compared. Univariable and multivariable analyses were performed to identify factors associated with the primary outcome of AKI. Survival was evaluated by Kaplan-Meier analysis. Results Of 38,775 EVAR patients identified, 86.5% underwent elective surgery for an intact aneurysm, 8.4% had urgent surgery for a symptomatic, intact aneurysm, and 5.1% had emergent repair for a ruptured aneurysm. Significant risk factors for AKI included contrast volume, a preoperative eGFR <30 mL/min, procedure urgency, COPD, congestive heart failure (CHF), and total procedure time. The factor most associated with AKI was aneurysm rupture prior to repair (OR 8.6, CI 7.2-10.3, P <.01). The association of contrast volume with the outcome was the least strong with a 4% increase in risk per 25 mL of contrast (OR 1.04, 95% CI 1.01-1.07). With the development of AKI, postoperative survival was reduced regardless of indication. Conclusions Of all factors assessed, aneurysm rupture was the most and contrast volume the least associated with AKI after EVAR. Further studies should evaluate methods of preventing post-EVAR AKI.

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“…This protocol is also in agreement with the KDIGO (Kidney Disease Improving Global Outcomes) and KDOQI (National Kidney Foundation's Kidney Disease Outcomes Quality Initiative) guidelines. 4,5 However, no guidelines have recommended a specific duration or volume of hydration. At present, in the United States, no insurance authorization will be given for preadmission to increase the length of preoperative hydration.…”

Section: Replymentioning

confidence: 99%

“…Patients exposed to the use of iodinated contrast have a higher risk of developing acute kidney injury, particularly at 48 and 72 hours. 4 In this study, serum creatinine values of the patients at 48 and 72 hours were not presented, precluding the detection of any postprocedural contrast-associated acute kidney injury.…”

mentioning

confidence: 91%