Incidence and predictors of early and delayed renal function decline after aortic aneurysm repair in the Vascular Quality Initiative database

Novak, Zdenek; Zaky, Ahmed; Spangler, Emily L.; McFarland, Graeme E.; Tolwani, Ashita J.; Beck, Adam W.

doi:10.1016/j.jvs.2021.04.049

Cited by 13 publications

(15 citation statements)

References 43 publications

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“…Multiple studies have found that patients undergoing complex EVAR requiring pararenal fixation to be at an increased risk of AKI. 5,10,11 This study confirms the impact of proximal aneurysm extent on ARF in patients undergoing EVAR for rupture; however, proximal aneurysm extent did not impact renal function after elective repair. This difference for elective repairs has been found in previous studies with Pisimisis finding proximal fixation to impact neither AKI nor CKD.…”

Section: Discussionsupporting

confidence: 70%

“…15 This finding is not surprising and has been well reported with multiple studies finding preoperative creatinine or eGFR to be associated with the development of AKI. 2,6,9,11 Many surgeons try to decrease contrast volume used in these patients or try preoperative hydration to decrease the risk of renal injury. Unfortunately, neither contrast volume nor hydration strategies can be ascertained from the NSQIP database.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] In addition, there are variable definitions of AKI after EVAR, ranging from small increases in serum creatinine to decreased postoperative urine output, and change in glomerular filtration rates. [8][9][10][11][12][13] While some of these definitions are based on established criteria such as the RIFLE, AKIN, or KDIGO staging systems, there is still variability in how this affects clinical outcomes. 2,10,12,13 Previous studies have shown decreased renal function to negatively impact both shortand long-term survival after EVAR.…”

Section: Introductionmentioning

confidence: 99%

“…2,10,12,13 Previous studies have shown decreased renal function to negatively impact both short- and long-term survival after EVAR. 11,12,14 In fact, Zarkowsky’s 2016 study found that of 56 patients requiring postprocedural dialysis less than twenty-five percent had three-year survival after elective endovascular aneurysm repair, which may mitigate the mortality benefit associated with elective endovascular AAA repair. 7 Therefore, the goal of this study was to determine clinical risk factors for acute renal failure (ARF) that required either temporary or permanent postoperative dialysis after EVAR both for elective aneurysm repair and emergent repair of ruptured aneurysms.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Acute Renal Failure After Endovascular Aneurysm Repair

Zambetti

Zickler

Byerly

et al. 2023

The American Surgeon™

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Background Acute kidney injury (AKI) after endovascular aortic aneurysm repair (EVAR) is uncommon though carries significant morbidity. Procedural risk factors are not well established for acute renal failure (ARF) that requires initiation of dialysis. The goal of this study was to examine the impact of ARF on patients undergoing EVAR and identify risk factors for ARF using a large, national dataset. Methods Patients undergoing EVAR were identified from the National Surgical Quality Improvement Program (NSQIP) database over 9 years, ending in 2019. Demographics, indication for repair, comorbidities, procedural details, complications, hospital and ICU LOS, and mortality were recorded. Patients were stratified by presence of ARF and compared. Patients were further stratified by indication for EVAR and presence of ARF. Multivariable logistic regression (MLR) analysis was performed to determine the independent predictors of ARF. Results 18 347 patients were identified. Of these 234 (1.3%) developed ARF requiring dialysis. Mortality (40 vs 1.8%, P < .0001), ICU LOS (5 vs 0 days, P < .0001), and hospital LOS (11 vs 2 days, P < .0001) were all significantly increased in patients with ARF. Multivariable logistic regression identified increasing diameter, creatinine, operative time, preoperative transfusions, ASA class, emergent repair, female gender, and juxtarenal/suprarenal proximal landing zone as predictors of ARF. Conclusions ARF after EVAR causes significant morbidity, prolongs hospitalizations, and increases mortality rates. Those patients at risk of ARF after EVAR should be closely monitored to reduce both morbidity and mortality.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Acute Renal Failure After Endovascular Aneurysm Repair

Zambetti

Zickler

Byerly

et al. 2023

The American Surgeon™

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“… 3 4 Despite various advantages of endovascular procedures, acute kidney injury (AKI) and renal function decline are common after aortic interventions. 5 Notably, postoperative AKI can increase the risk of mortality after all types of aortic repair 6 ; thus, how to diminish the incidence of AKI after endovascular aortic repair is of great importance.…”

Section: Introductionmentioning

confidence: 99%

Randomised controlled trial to evaluate the effect of contrast material dilution on renal function in patients after endovascular aortic repair: rationale and design for the CULTURE trial

et al. 2023

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IntroductionPostoperative renal function decline is a major concern for thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Diluting contrast medium in the power injector may be helpful in reducing the risk of contrast-induced nephropathy, but it can also blur fluoroscopic vision during surgery. The quality of the current evidence is very low; thus, this study is designed to investigate the effect of contrast dilution in the power injector on renal function changes in patients after endovascular aortic repair.Method and analysisThe study is a prospective, single-blind, parallel, non-inferiority, randomised controlled trial with two independent cohorts: Cohort TEVAR and EVAR. Individuals will enter the appropriate cohort based on clinical interviews if they meet the eligibility criteria. Participants in Cohort TEVAR and EVAR will be randomly allocated to the intervention group (diluting contrast medium to 50% in the power injector) and control group (pure contrast medium in the power injector) separately in a 1:1 ratio. The primary study points consist of the proportion of patients who develop acute kidney injury within 48 hours after TEAVR or EVAR (first stage) and freedom of major adverse kidney events at 12 months after TEAVR or EVAR (second stage). The safety endpoint is freedom of all types of endoleaks at 30 days after TEVAR or EVAR. Follow-up will be conducted at 30 days and 12 months after intervention.Ethics and disseminationThe trial was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (approval number: 20201290). The results of the study will be disseminated through publications in peer-reviewed journals and presentations at academic conferences.Trial registration numberChinese Clinical Trial Registry (ChiCTR2100042555).

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