Abstract

ABREU, Rodolfo et al. Impact of chronic kidney disease on prognosis after abdominal aortic aneurysm repair convencional surgery vs Endovascular Aneurysm Repair. Angiol Cir Vasc [online]. 2016, vol.12, n.2, pp.77-84. ISSN 1646-706X.  https://doi.org/10.1016/j.ancv.2016.01.008.

Introduction: Surgical repair of AAA through EVAR or conventional surgery (CS) can worsen renal function in the short-term. This complication, more common in patients with CKD, is associated with worse long-term prognosis. The aim of this study was to quantify the deterioration of renal function after AAA repair in patients with previous IRC and demonstrate the resulting increase in morbidity and mortality. Methods: Retrospective study of patients with CKD stages 3-4 (eGFR 15-59 mL/min) undergoing elective repair of AAA between February/2011 and February/2015 in a tertiary institution. Studied variables: age, gender, type of intervention (CS/EVAR) and CKD stage. Endpoints: change in creatinine and GFR with surgery, postoperative renal complications, need for another surgical intervention and mortality. Statistical analysis was performed in SPSS. Results: We included 71 patients. Fifteen (21%) underwent CS and 56 (78%) EVAR. At the time of intervention, patients had the following stages of CKD: CKD 3 -65 (91%); CKD 4 -6 (9%). GFR change with surgery was −1.08 ± 18.01 mg/dl. Worsened postoperative IRC occurred in 22 (31%) patients and 5 (7%) needed dialysis. Overall mortality was 8.5%. Patients operated by EVAR had more advanced CKD preoperatively, but showed less worsening of renal function. GFR variation: EVAR 14.1 ± 16.26 ml/min vs CS −9.40 ± 22.11 ml/min (p = 0.022); creatinine variation: EVAR 0.17 ± 1.03 mg/dl vs CS 0.81 ± 1.47 mg/dl (p = 0.02). CKD worsening was superior in the CS group (53.3% vs 28.6%; p = 0.072) as well as the need for dialysis (20% vs 3.6%, p = 0.06). The 6 patients that died (EVAR: 3; CC: 3) showed greater worsening of renal function (creatinine variation: 1.41 ± 1.63 mg/dl vs. 0.20 ± 1.07 mg/dl, p = 0.001; GFR change: −19.0 ± 16.55 ml/min; 0.57 ± 17.34 ml/min, p = 0.007) and need for dialysis. Conclusion: The results showed a trend towards a lower probability of acute renal failure, less need of post-operative dialysis and lower mortality in patients treated by EVAR. However, the medium/long term impact of contrast administration, due to post-EVAR surveillance programs, should be regarded. We believe that it is possible to consider that the use of EVAR for the treatment of patients with AAA and CKD is a procedure at least as safe as CS.

Keywords : Abdominal Aortic Aneurysm; Chronic Kidney Disease; Acute Renal Failure; Endovascular Aneurysm Repair.

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