Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 12/2016

01-12-2016 | Original Article

Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome

Authors: Naoki Toya, Takao Ohki, Yasutake Momokawa, Kota Shukuzawa, Soichiro Fukushima, Hiromasa Tachihara, Tadashi Akiba

Published in: Surgery Today | Issue 12/2016

Login to get access

Abstract

Purpose

Renal insufficiency is associated with increased morbidity and death after endovascular aortic aneurysm repair (EVAR). However, the effect of postoperative acute kidney dysfunction on patient outcome has not been fully determined. This study aimed to determine the risk factors of early postoperative renal function decline using chronic kidney disease (CKD) staging and its effect on the clinical outcome.

Methods

A retrospective analysis was performed on a prospectively maintained EVAR database. Pre- and postoperative CKD stages were determined for all patients according to the estimated glomerular filtration rate values.

Results

We identified 135 patients who were treated with elective EVAR. CKD stage decline was observed in 25 (19 %) of the patients. Freedom from aneurysm-related death was significantly lower in patients with postoperative CKD progression compared with those with unchanged CKD stage. A shaggy aorta without oral beta-blocker administration and higher preoperative serum creatinine levels (>1.4 mg/dL) were found to be independent predictors of an early postoperative CKD stage decline.

Conclusions

Patients with postoperative CKD progression have an increased frequency of aneurysm-related death. The presence of a shaggy aorta, absence of oral beta-blocker administration and an increased preoperative creatinine level are independent predictors of early postoperative CKD progression.
Literature
1.
De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven ELG, Cuypers PWM, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362(20):1881–9.CrossRefPubMed
2.
Wald R, Waikar SS, Liangos O, Pereira BJG, Chertow GM, Jaber BL. Acute renal failure after endovascular vs open repair of abdominal aortic aneurysm. J Vasc Surg. 2006;43(3):460–6 (discussion 466).CrossRefPubMed
3.
Greenberg RK, Chuter TAM, Lawrence-Brown M, Haulon S, Nolte L. Zenith Investigators. Analysis of renal function after aneurysm repair with a device using suprarenal fixation (Zenith AAA Endovascular Graft) in contrast to open surgical repair. J Vasc Surg. 2004;39(6):1219–28.CrossRefPubMed
4.
Hua HT, Cambria RP, Chuang SK, Stoner MC, Kwolek CJ, Rowell KS, et al. Early outcomes of endovascular versus open abdominal aortic aneurysm repair in the National Surgical Quality Improvement Program-Private Sector (NSQIP-PS). J Vasc Surg. 2005;41(3):382–9.CrossRefPubMed
5.
Zeebregts CJ, Geelkerken RH, van der Palen J, Huisman AB, de Smit P, van Det RJ. Outcome of abdominal aortic aneurysm repair in the era of endovascular treatment. Br J Surg. 2004;91(5):563–8.CrossRefPubMed
6.
Mehta M, Veith FJ, Lipsitz EC, Ohki T, Russwurm G, Cayne NS, et al. Is elevated creatinine level a contraindication to endovascular aneurysm repair? J Vasc Surg. 2004;39(1):118–23.CrossRefPubMed
7.
Azizzadeh A, Sanchez LA, Miller CC, Marine L, Rubin BG, Safi HJ, et al. Glomerular filtration rate is a predictor of mortality after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2006;43(1):14–8.CrossRefPubMed
8.
Mills JL, Duong ST, Leon LR, Goshima KR, Ihnat DM, Wendel CS, et al. Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate. J Vasc Surg. 2008;47(6):1141–9.CrossRefPubMed
9.
Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2001;37(1 Suppl 2):S66–70.CrossRefPubMed
10.
Hollier LH, Kazmier FJ, Ochsner J, Bowen JC, Procter CD. “Shaggy” aorta syndrome with atheromatous embolization to visceral vessels. Ann Vasc Surg. 1991;5(5):439–44.CrossRefPubMed
11.
Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med. 1994;331(22):1474–9.CrossRefPubMed
12.
Fukuda I, Daitoku K, Minakawa M, Fukuda W. Shaggy and calcified aorta: surgical implications. Gen Thorac Cardiovasc Surg. 2013;61(6):301–13.CrossRefPubMed
13.
Toya N, Baba T, Kanaoka Y, Ohki T. Embolic complications after endovascular repair of abdominal aortic aneurysms. Surg Today. 2014;44(10):1893–9.CrossRefPubMed
14.
Prinssen M, Verhoeven ELG, Buth J, Cuypers PWM, van Sambeek MRHM, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607–18.CrossRefPubMed
15.
Greenhalgh RM, Brown LC, Kwong GPS, Powell JT, Thompson SG. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-days operative mortality results: randomised controlled trial. Lancet. 2004;364(9437):843–8.CrossRefPubMed
16.
Parmer SS, Fairman RM, Karmacharya J, Carpenter JP, Velazquez OC, Woo EY. A comparison of renal function between open and endovascular aneurysm repair in patients with baseline chronic renal insufficiency. J Vasc Surg. 2006;44(4):706–11.CrossRefPubMed
17.
Alsac J-M, Zarins CK, Heikkinen MA, Karwowski J, Arko FR, Desgranges P, et al. The impact of aortic endografts on renal function. J Vasc Surg. 2005;41(6):926–30.CrossRefPubMed
18.
Barrett BJ, Parfrey PS. Clinical practice. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006;354(4):379–86.CrossRefPubMed
19.
Aspelin P, Aubry P, Fransson S-G, Strasser R, Willenbrock R, Berg KJ, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348(6):491–9.CrossRefPubMed
20.
Saratzis AN, Goodyear S, Sur H, Saedon M, Imray C, Mahmood A. Acute kidney injury after endovascular repair of abdominal aortic aneurysm. J Endovasc Ther. 2013;20(3):315–30.CrossRefPubMed
21.
Sharma SK, Kini A. Effect of nonionic radiocontrast agents on the occurrence of contrast-induced nephropathy in patients with mild-moderate chronic renal insufficiency: pooled analysis of the randomized trials. Catheter Cardiovasc Interv. 2005;65(3):386–93.CrossRefPubMed
22.
Nguyen B-N, Neville RF, Rahbar R, Amdur R, Sidawy AN. Comparison of outcomes for open abdominal aortic aneurysm repair and endovascular repair in patients with chronic renal insufficiency. Ann Surg. 2013;258(3):394–9.CrossRefPubMed
23.
Parmer SS, Carpenter JP, Endologix Investigators. Endovascular aneurysm repair with suprarenal vs infrarenal fixation: a study of renal effects. J Vasc Surg. 2006;43(1):19–25.CrossRefPubMed
24.
Cayne NS, Rhee SJ, Veith FJ, Lipsitz EC, Ohki T, Gargiulo NJ, et al. Does transrenal fixation of aortic endografts impair renal function? J Vasc Surg. 2003;38(4):639–44.CrossRefPubMed
25.
Alric P, Hinchliffe RJ, Picot M-C, Braithwaite BD, MacSweeney STR, Wenham PW, et al. Long-term renal function following endovascular aneurysm repair with infrarenal and suprarenal aortic stent-grafts. J Endovasc Ther. 2003;10(3):397–405.PubMed
26.
Davey P, Peaston R, Rose JD, Jackson RA, Wyatt MG. Impact on renal function after endovascular aneurysm repair with uncovered supra-renal fixation assessed by serum cystatin C. Eur J Vasc Endovasc Surg. 2008;35(4):439–45.CrossRefPubMed
27.
Saratzis A, Sarafidis P, Melas N, Hunter JP, Saratzis N, Kiskinis D, et al. Suprarenal graft fixation in endovascular abdominal aortic aneurysm repair is associated with a decrease in renal function. J Vasc Surg. 2012;56(3):594–600.CrossRefPubMed
28.
Walsh SR, Tang T, Gaunt ME, Boyle JR. Contrast-induced nephropathy. J Endovasc Ther. 2007;14(1):92–100.CrossRefPubMed
29.
Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int. 1995;47(1):254–61.CrossRefPubMed
30.
Durham JD, Caputo C, Dokko J, Zaharakis T, Pahlavan M, Keltz J, et al. A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int. 2002;62(6):2202–7.CrossRefPubMed
31.
Koutouzi G, Henrikson O, Roos H, Zachrisson K, Falkenberg M. EVAR guided by 3D image fusion and CO2 DSA: a new imaging combination for patients with renal insufficiency. J Endovasc Ther. 2015;22(6):912–7.CrossRefPubMed
32.
Bakris GL, Fonseca V, Katholi RE, McGill JB, Messerli FH, Phillips RA, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA. 2004;292(18):2227–36.CrossRefPubMed
33.
Fassbinder W, Quarder O, Waltz A. Treatment with carvedilol is associated with a significant reduction in microalbuminuria: a multicentre randomised study. Int J Clin Pract. 1999;53(7):519–22.PubMed
Metadata
Title
Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome
Authors
Naoki Toya
Takao Ohki
Yasutake Momokawa
Kota Shukuzawa
Soichiro Fukushima
Hiromasa Tachihara
Tadashi Akiba
Publication date
01-12-2016
Publisher
Springer Japan
Published in
Surgery Today / Issue 12/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-016-1324-6

Other articles of this Issue 12/2016

Surgery Today 12/2016 Go to the issue

Review Article

Cerebral malperfusion in acute aortic dissection

Original Article

Hyperfibrinogenemia is associated with inflammatory mediators and poor prognosis in patients with gastric cancer

Original Article

The effects of bevacizumab on intestinal anastomotic healing in rabbits

Original Article

Clinical value and pitfalls of fluorescent cholangiography during single-incision laparoscopic cholecystectomy

How to Do It

Omental flap after pelvic exenteration for pelvic cancer

Original Article

The effects of roflumilast on the pancreas and remote organs in a cerulein-induced experimental acute pancreatitis model in rats