Impact of acute kidney injury on long-term outcomes after fenestrated and branched endovascular aortic aneurysm repair.

Autor:	Dossabhoy SS; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Simons JP; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Crawford AS; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Aiello FA; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Judelson DR; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Arous EJ; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Messina LM; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass., Schanzer A; UMass Memorial Center for Complex Aortic Disease, University of Massachusetts Medical School, Worcester, Mass. Electronic address: andres.schanzer@umassmemorial.org.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2020 Jul; Vol. 72 (1), pp. 55-65.e1. Date of Electronic Publication: 2019 Dec 14.
DOI:	10.1016/j.jvs.2019.09.034
Abstrakt:	Objective: Acute kidney injury (AKI) has been identified as a common complication after fenestrated and branched endovascular aneurysm repair (F/BEVAR), occurring in 5% to 29% of patients. Predictors of AKI and its impact on long-term outcomes remain unknown. We sought to identify independent predictors of AKI and its effect on long-term survival after F/BEVAR. Methods: A single-institution retrospective review of all consecutive F/BEVAR procedures was performed (November 2010-September 2018). Data were collected prospectively through an Institutional Review Board-approved registry and a physician-sponsored investigational device exemption clinical trial (G130210). AKI was defined as a decrease in estimated glomerular filtration rate by >30% from baseline, within 30 days postoperatively. The cohort was stratified according to whether a patient experienced AKI. Demographics, operative details, perioperative complications, and length of stay between groups were compared. The primary outcome, long-term survival, was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling. Independent predictors of AKI were identified using logistic regression. Results: Among 219 consecutive F/BEVAR patients, AKI occurred in 41 patients (19%) and was the most common 30-day complication observed. Whereas preoperative creatinine concentration, estimated glomerular filtration rate, and target renal artery stenosis >50% did not predict AKI, the occurrence of intraoperative complications did correlate with AKI (37% vs 7.3%; P < .01). By 30 days, AKI resolved in 7 (17%) patients, persisted without need for dialysis in 26 (64%), and progressed to dialysis in 5 (12%); the remaining 3 (7%) patients died. Survival at 30 days was significantly lower in the AKI group (92.7% vs 98.9%; P = .047), and this difference persisted at 1 year (68% vs 87%; log-rank, P <.01) and 3 years (44% vs 60%; log-rank, P = .04). On multivariable modeling, AKI increased the hazard of death nearly twofold (hazard ratio, 1.92; 95% confidence interval [CI], 1.11-3.23; P = .019). Independent predictors of AKI on multivariable logistic regression were intraoperative complications (odds ratio, 4.10; 95% CI, 1.61-10.42; P < .01) and increased operating room time (odds ratio, 1.56; 95% CI, 1.22-2.00; P < .01). Conclusions: In our 8-year experience of F/BEVAR, AKI was the most common postoperative complication observed in nearly 20% of patients. AKI after F/BEVAR is associated with decreased short- and long-term survival. Whether AKI is causative or just associated with decreased survival remains to be elucidated. Further study is needed to determine whether the independent predictors of AKI, including intraoperative complications and operating room time, are generalizable across all centers performing F/BEVAR and to investigate how we might further mitigate this common and serious complication. (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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