The risk of renal function deterioration in abdominal aortic stent graft patients with and without previous kidney function failure – an analysis of risk factors

Abstract

Purpose: Kidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up. Material and methods:A total of 214 endovascularly treated AAA patients were included. In all cases, pre-and postoperative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years. Results:The baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m 2 . Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endovascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance.Conclusions: Angio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.

Incidence of Contrast-Induced Nephropathy and Post-Operative Outcomes in Patients Undergoing Chimney Endovascular Aortic Aneurysm Repair

“…15 However, in another cohort including 214 patients treated with EVAR, no correlation was found between CM volume and the final eGFR. 20 In our cohort, we did not find a significant difference in the amount of CM used between the patients who developed CI-AKI and those who did not (90.0 vs 84 mL, P = .583). This may be partly explained by an “as low as reasonably achievable” approach in our center.…”

“…12,13 Previous studies reported an incidence of CI-AKI in patients undergoing EVAR between 6.9 and 28%. 12,[14][15][16][17][18][19][20] In the present cohort of 102 patients, we report for the first time, the incidence of CI-AKI specifically in patients who underwent ch-EVAR, with a rate of 13.7%, which is within the low range compared with other EVAR procedures. In our center, we applied an "as low as reasonably achievable" approach and the median of CM used was low (85 mL), which could partly explain a relatively low rate of incidence of CI-AKI.…”

“…[9][10][11] The occurrence of CI-AKI has been reported during diagnostic or therapeutic procedures in patients with vascular diseases, including aortic aneurysms. 12,13 While several studies reported its incidence in patients undergoing EVAR, [14][15][16][17][18][19][20] none of them has specifically addressed this issue in the context of ch-EVAR. This study aims to report the occurrence of CI-AKI in patients undergoing ch-EVAR and to investigate its association with post-operative outcomes.…”

Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch

“…Also, in the case of a more extensive dissection, kidneys adjust to a physiologically abnormal level of perfusion. Therefore, recovering a physiologically typical flow split after surgery may lead to the deterioration of renal function [75]. Additionally, due to the added aortic compliance introduced by the use of a compliant graft, EL decreased by 4% in the BC1 case compared to the baseline.…”