Risk Factors for Renal Dysfunction Following Endovascular Aortic Aneurysm Repair

Takashi Otani, Masataka Hirata, Naoto Izawa, Tatsuo Motoki, Atsushi Kurushima, Yoshiaki Fukumura

TOKUSHIMA RED CROSS HOSPITAL, TOKUSHIMA, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–A

Abstract

We examined the risk factors for renal dysfunction after endovascular aortic aneurysm repair (EVAR) and the optimal approaches to prevent. We performed EVAR in 139 patients during the period from October 2009 to June 2017. The patients were divided into the following two groups according to changes in chronic kidney disease (CKD) stage 6 months after the operation : group A, patients with deterioration of their CKD stage (n=39); and group B, patients with no deterioration (n=100). We compared the two groups on age, gender, CKD stage, operation time, device used, shaggy aorta, contrast medium use and so on.

We defined descending shaggy aorta as follows ( thickness > 3mm, length > 3cm, circumference of aorta > 50% ). We defined shaggy aorta around the renal arteries as follows (thickness > 3mm, length > 1cm, circumference of aorta > 50% ). We defined extended shaggy aorta as descending shaggy aorta + shaggy aorta around the renal arteries.

Multivariate logistic regression analysis identified extended shaggy aorta as risk factor for postoperative renal dysfunction. (95% CI=3.3-81.0; p=0.0006).

Next, we specifically analyzed patients with a preoperative CKD stage >3. An extended shaggy aorta (95% CI=2.1-192.5; p=0.009) and intraoperative contrast media volumes (95% CI=0.98-0.99; p=0.03) were found to be risk factors for renal dysfunction in this group. When comparing outcomes after EVAR or open surgery in patients with extended shaggy aortas, we found that renal function significantly deteriorated in patients receiving EVAR (EVAR vs Open surgery p=0.002). Open surgery should be the first option for the treatment of patients with extended shaggy aorta.