Cucuruz, Beatrix and Kasprzak, Piotr M. and Gallis, Konstantinos and Schierling, Wilma and Pfister, Karin and Kopp, Reinhard (2020) Midterm outcome of renal function after branched thoracoabdominal aortic aneurysm repair. JOURNAL OF VASCULAR SURGERY, 71 (4). pp. 1119-1127. ISSN 0741-5214,
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Objective: The aim of this study was to investigate the incidence and impact of acute and chronic kidney dysfunction after branched endovascular aortic aneurysm repair (BEVAR) perioperatively and during follow-up. Methods: Patients with a thoracoabdominal aortic aneurysm were treated with BEVAR. Serum creatinine; estimated glomerular filtration rate at baseline, after 48 hours, at discharge, and after 1 and two years; perioperative results; and outcome during follow-up were evaluated. Results: Treatment of thoracoabdominal aortic aneurysm using BEVAR was performed in 113 patients (mean age, 71 years; 79 male) with 434 side branches and two additional fenestrations (0.46%) for renovisceral perfusion. Sixty patients (53%) underwent staged procedures with temporary aneurysm sac perfusion and secondary side branch completion. Perioperative mortality was 9 of 113 (8%). Postoperative acute kidney injury (AKI) was observed in 41 of 113 patients (36%) with recovery of renal function after 2 years in most patients. However, chronic kidney disease (CKD) stage progression after 1 and 2 years was observed in 25 of 104 patients (24%) and 17 of 52 patients (32.7%), respectively. Seven patients (6.7%) required permanent dialysis during 2 years of follow-up. Risk factors for AKI were nonstaged procedures (P = .02) and multiorgan failure (P = .01). CKD progression was related to renal branch reinterventions (P = .047), all branch reinterventions (P = .03), and postoperative AKI (P = .001). During follow-up, survival was decreased in patients with AKI, especially in those with nonmalignant diseases (P = .01). Conclusions: Postoperative AKI after BEVAR was observed in about one-third of patients associated with increased CKD stages after 2 years. Preoperative CKD was not a risk factor for postoperative AKI or perioperative outcome. The prevention of AKI by staged procedures, early interventions for renal side branch complications, and regular surveillance is recommended to improve outcomes.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE KIDNEY INJURY; FAILURE; DISEASE; INCREASES; DIALYSIS; RIFLE; RISK; Branched endovascular aortic repair (BEVAR); Staged procedure; Temporary aneurysm sack perfusion (TASP); Acute kidney injury (AKI); Chronic kidney disease (CKD) |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Abteilung für Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 29 Mar 2021 07:12 |
| Last Modified: | 29 Mar 2021 07:12 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44869 |
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