Abstract
Objective:
Acute kidney injury (AKI) is a well known complication following cardiovascular procedures. The objective of this study was to assess incidence, risk factors, and the prognostic significance of AKI following infrarenal endovascular aneurysm repair (EVAR) and complex EVAR (c-EVAR).
Methods:
Consecutive patients undergoing elective infrarenal EVAR or c-EVAR between 2000 and 2018 in two large teaching hospitals in the Netherlands were included. The primary outcome was incidence of peri-operative AKI development. Secondary outcomes included midterm renal function (RIFLE criteria), overall survival, and risk factors for AKI development. To determine survival and risk factors for AKI, multivariable analyses were performed, accounting for pre-operative renal function and other confounders.
Results:
Five hundred and forty patients were included who underwent infrarenal EVAR and 147 patients who underwent c-EVAR. Incidence of AKI was 8.7% (n = 47) in infrarenal EVAR patients, and 23% (n = 34) in c-EVAR patients (fenestrated EVAR 18%/branched EVAR 38%). After risk adjusted analysis, compared with non-AKI, post-operative AKI development was associated with higher three year mortality following both infrarenal and c-EVAR (infrarenal EVAR mortality HR 1.6 [95% CI 1.01 – 2.7], p = .046; c-EVAR mortality HR 2.4 [95% CI 1.1 – 5.2], p =.033). Following multivariable logistic regression, pre-operative chronic kidney disease (eGFR < 60; OR 2.2 [95% CI 1.03 – 4.8]) and neck diameter (OR[/mm] 1.1 [95% CI 1.01 – 1.2]) were statistically significantly associated with AKI following infrarenal EVAR, whereas for c-EVAR only contrast volume (OR[/10cc] 1.1 [95% CI 1.0 – 1.2]) was found to be statistically significantly associated with AKI.
Conclusion:
AKI is a well described complication following infrarenal EVAR and is common after c-EVAR. As AKI seems to be associated with permanent renal deterioration and lower survival, efforts to prevent AKI are essential.
Acute kidney injury (AKI) is a well known complication following cardiovascular procedures. The objective of this study was to assess incidence, risk factors, and the prognostic significance of AKI following infrarenal endovascular aneurysm repair (EVAR) and complex EVAR (c-EVAR).
Methods:
Consecutive patients undergoing elective infrarenal EVAR or c-EVAR between 2000 and 2018 in two large teaching hospitals in the Netherlands were included. The primary outcome was incidence of peri-operative AKI development. Secondary outcomes included midterm renal function (RIFLE criteria), overall survival, and risk factors for AKI development. To determine survival and risk factors for AKI, multivariable analyses were performed, accounting for pre-operative renal function and other confounders.
Results:
Five hundred and forty patients were included who underwent infrarenal EVAR and 147 patients who underwent c-EVAR. Incidence of AKI was 8.7% (n = 47) in infrarenal EVAR patients, and 23% (n = 34) in c-EVAR patients (fenestrated EVAR 18%/branched EVAR 38%). After risk adjusted analysis, compared with non-AKI, post-operative AKI development was associated with higher three year mortality following both infrarenal and c-EVAR (infrarenal EVAR mortality HR 1.6 [95% CI 1.01 – 2.7], p = .046; c-EVAR mortality HR 2.4 [95% CI 1.1 – 5.2], p =.033). Following multivariable logistic regression, pre-operative chronic kidney disease (eGFR < 60; OR 2.2 [95% CI 1.03 – 4.8]) and neck diameter (OR[/mm] 1.1 [95% CI 1.01 – 1.2]) were statistically significantly associated with AKI following infrarenal EVAR, whereas for c-EVAR only contrast volume (OR[/10cc] 1.1 [95% CI 1.0 – 1.2]) was found to be statistically significantly associated with AKI.
Conclusion:
AKI is a well described complication following infrarenal EVAR and is common after c-EVAR. As AKI seems to be associated with permanent renal deterioration and lower survival, efforts to prevent AKI are essential.
| Original language | English |
|---|---|
| Pages (from-to) | 6S-7S |
| Number of pages | 2 |
| Journal | Journal of Vascular Surgery |
| Volume | 77 |
| Issue number | 4 |
| Publication status | Published - Nov 2023 |