Risk factors and impact of proximal fixation on acute and chronic renal dysfunction after endovascular aortic aneurysm repair using glomerular filtration rate criteria

George T. Pisimisis, Carlos F. Bechara, Neal R. Barshes, Peter H. Lin, Win S. Lai, Panagiotis Kougias

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Background: The incidence of renal impairment relevant to proximal fixation of aortic endograft devices remains unclear. Methods: Retrospective cohort of 208 consecutive patients that underwent EVAR from 2006 to 2011. Estimated glomerular filtration rate (eGFR) was based on MDRD study equation. Acute kidney injury (AKI) and chronic kidney disease (CKD) were classified with ADIQ/RIFLE criteria and National Kidney Foundation criteria, respectively. Kaplan-Meier curve was applied to evaluate progression to CKD. Multivariate regression model was fit to identify predictors for developing AKI and CKD. Results: Suprarenal fixation group (SF) included 110 patients and infrarenal fixation group (IF) included 98 patients. Both groups had similar demographics, baseline eGFR, and renal-protection protocols. There was a trend for decreased use of contrast in IF group (median: 93.5 vs. 103 cc, P = 0.07). AKI occurred in 15% of patients in SF group and 19% of patients in IF group (RR: 1.24, P = 0.47). The freedom from progression to stage 3 or 4 CKD in the SF group was 0.76, 0.72, and 0.49 at 6, 12, and 18 months, respectively, while for IF group was 0.8, 0.73, and 0.68, respectively (P = 0.4). Increasing age (P = 0.07), lengthy procedures (P < 0.001), and baseline renal dysfunction (P < 0.001) were significant predictors for developing CKD. Contrast volume (P < 0.001) and ace-inhibitors (P = 0.07) were predictors for AKI. Conclusion: Proximal fixation type has no significant effect on both acute and chronic renal function. Identification of modifiable perioperative risk factors may be used to improve renal function outcomes.

Original languageEnglish (US)
Pages (from-to)16-22
Number of pages7
JournalAnnals of Vascular Surgery
Volume27
Issue number1
DOIs
StatePublished - Jan 2013

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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