Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury

Abstract

Objective: Patients undergoing endovascular aneurysm repair (EVAR) have comorbidities that increase the risk of death, myocardial infarction (MI) and acute kidney injury (AKI). Our aim was to evaluate the incidence and predictors of mortality, MI and AKI after EVAR and to compare AKI incidence with Vascular Surgery Kidney Injury Predictive Score (VSKIPS). Methods: We conducted a retrospective study of EVAR procedures performed between March 2006 and November 2013. We defined mortality at 30 days, MI as an increase in troponin level to >0.034 ng mL -1 in the first 72 h and AKI as an increase in creatinine level to >0.3 mg dL -1 in the first 48 h after surgery. Risk factors were analysed using logistic regression calculating Hosmer-Lemeshow test and the area under the receiver operating curve (AUROC). Results: Ninety-eight patients were included in the study. The incidence of mortality, MI, and AKI was 2%, 5%, and 18%, respectively. AKI increased the risk of MI [odds ratio (OR) 24.4, p=0.006]. Preoperative serum urea level of >50 mg dL -1 (OR 4.97, p=0.038), general anaesthesia (OR 9.64, p=0.002) and surgery duration (OR 1.53, p=0.043) were considered independent predictors of AKI. The AUROC of the AKI model was 0.886 compared with 0.793 of VSKIPS. Conclusion: We found the incidence of mortality, MI and AKI consistent with that of previous studies. However, we may be underestimating the last two because of the short follow-up time. AKI was an independent predictor of MI. Preoperative serum urea level of >50 mg dL

Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…69 In recent years, however, studies that have used standardized criteria for AKI have reported an incidence of AKI after EVAR for infrarenal AAA of 9%-21% (Table 4). [70][71][72][73][74][75][76][77][78][79][80][81] Open repair is associated with a 1.6-to 2-fold higher risk of AKI but better long-term preservation of kidney function 59,80,82 than EVAR. Juxtarenal, suprarenal, or thoracoabdominal aneurysms cannot be treated with standard "off the shelf " EVAR devices and require individualized fenestrated EVAR (fEVAR) or branched EVAR devices (Figure 3), which are associated with considerably higher rates of AKI.…”

Complications of endo-vascular aortic repair for abdominal aortic aneurysm: A retrospective single-centre experience

“…According to the European Society of Cardiology (ESC)/European Society of Anesthesiology (ESA) guidelines, EVAR is an intermediate cardiac risk procedure, with a 1%–5% incidence of cardiac events (MI or cardiac death) [ 2 ]. In our study, all patients had ASA risk score ≥ 3 (31 patients (72.1%) had ASA-3 and 12 patients (27.9%) ASA-4).…”

“…AAA is a common disease that constitutes a serious health problem [ 1 , 2 ]. It particularly affects men older than 60 years with a prevalence that ranges from 2% to 7% [ 1 , 2 ]. In 1991, Parodi, Palmaz, and Barone reported the first EVAR for AAA [ 3 ].…”

Diseases of the Aorta and Kidney Disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…As discussed above, AKI develops in 15–20% of patients having elective EVAR for infrarenal AAA. 53 , 59–68 , 76 Whether open repair is associated with a lower, equal, or higher AKI risk is not yet clear. Saratzis et al .…”