Incidence and Outcomes of Severe Renal Impairment Following Ruptured Abdominal Aortic Aneurysm Repair

Autor: Paul D. Hayes, Patrick A. Coughlin, Jonathan R. Boyle, Kevin Varty, Manjit S. Gohel, Graeme K. Ambler
Rok vydání: 2015
Předmět:
Male
Time Factors
Kaplan-Meier Estimate
urologic and male genital diseases
Severity of Illness Index
Aortic aneurysm
chemistry.chemical_compound
Risk Factors
Medicine
Aortic Aneurysm
Abdominal/diagnosis
Medicine(all)
Aged
80 and over
Incidence
Mortality rate
Endovascular Procedures
Acute kidney injury
Acute Kidney Injury
female genital diseases and pregnancy complications
Aortic Rupture/diagnosis
Treatment Outcome
England
Creatinine
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Acute Kidney Injury/diagnosis
Aortic Rupture
Aortography
Blood Vessel Prosthesis Implantation
Aneurysm
Severity of illness
Humans
Abdominal
Endovascular Procedures/adverse effects
England/epidemiology
Blood Vessel Prosthesis Implantation/adverse effects
Aged
Proportional Hazards Models
Retrospective Studies
business.industry
Proportional hazards model
Retrospective cohort study
Survival analysis
Creatinine/blood
medicine.disease
Surgery
chemistry
Aortography/methods
Tomography
X-Ray Computed
business
Biomarkers/blood
Biomarkers
Aortic Aneurysm
Abdominal
Zdroj: Ambler, G K, Coughlin, P A, Hayes, P D, Varty, K, Gohel, M S & Boyle, J R 2015, ' Incidence and Outcomes of Severe Renal Impairment Following Ruptured Abdominal Aortic Aneurysm Repair ', European Journal of Vascular and Endovascular Surgery, vol. 50, no. 4, pp. 443-449 . https://doi.org/10.1016/j.ejvs.2015.06.024
ISSN: 1078-5884
DOI: 10.1016/j.ejvs.2015.06.024
Popis: INTRODUCTION: Acute kidney injury (AKI) following ruptured abdominal aortic aneurysm (rAAA) repair is common and multifactorial. A standard definition of AKI after endovascular repair (EVAR), the Aneurysm Renal Injury Score (ARISe), has been proposed to facilitate standardised reporting and thus improve understanding of this issue.METHODS: Data were collected retrospectively on AKI in a prospectively maintained database of all patients treated for rAAA in a single tertiary referral centre since the availability of routine out of hours emergency EVAR. The ARISe score was used to describe the degree of AKI and factors which correlated with poor renal outcomes were assessed.RESULTS: Two-hundred and five patients were treated between January 2006 and April 2014. Of these, 125 were treated with open repair (OSR) and 80 were treated with EVAR. Severe AKI (defined as ARISe score ≥3) occurred in 36% of patients. After correction for confounders, patients treated with OSR were significantly more likely to develop severe AKI (43% vs. 26%, p = .02). There was no significant difference in preoperative serum creatinine between groups, but increased preoperative serum creatinine was strongly associated with severe AKI postoperatively (p < .001). Age, sex, endograft type, and preoperative CT scanning were not associated with differences in renal outcomes. Clamp position above renal arteries was predictive of severe AKI in patients treated with OSR (p < .01). Patients suffering severe AKI had significantly higher mortality at 30 days and 12 months (28% vs. 5% and 44% vs. 13%, p < .001 for both comparisons).CONCLUSION: Severe AKI is common following successful repair of rAAA. In this large case series of high-risk patients, OSR was associated with significantly higher rates of severe AKI compared with EVAR, despite the increased dose of contrast involved in EVAR and the older age of these patients. In turn, severe AKI was associated with higher mortality rates.
Databáze: OpenAIRE
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