Is Endovascular Aneurysm Repair a Relative Contraindication for Patients with Preoperative Renal Dysfunction?

Tadashi Furuyama; Toshihiro Onohara; Keita Mikasa; Jyunji Kishimoto; Masafumi Yamashita; Minoru Okamoto; Tsuyoshi Yamamoto; Yasushi Shimoe; Masahiro Okada; Toshiki Takahashi; Yoshimitsu Ishibashi; Mikizou Nakai; Hitoshi Suhara; Fuminari Kasashima; Masamitsu Endo; Takeshi Nishina; Jyunichi Kei; Akihiro Mizuno; Nobuhiro Handa

doi:10.3400/avd.oa.15-00072

Selection from the Journal of Japanese College of Angiology 2014

Is Endovascular Aneurysm Repair a Relative Contraindication for Patients with Preoperative Renal Dysfunction?

Tadashi Furuyama, Toshihiro Onohara, Keita Mikasa, Jyunji Kishimoto, Masafumi Yamashita, Minoru Okamoto, Tsuyoshi Yamamoto, Yasushi Shimoe, Masahiro Okada, Toshiki Takahashi, Yoshimitsu Ishibashi, Mikizou Nakai, Hitoshi Suhara, Fuminari Kasashima, Masamitsu Endo, Takeshi Nishina, Jyunichi Kei, Akihiro Mizuno, Nobuhiro Handa

Author information

Tadashi Furuyama
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Toshihiro Onohara
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Keita Mikasa
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Jyunji Kishimoto
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Masafumi Yamashita
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Minoru Okamoto
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Tsuyoshi Yamamoto
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Yasushi Shimoe
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Masahiro Okada
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Toshiki Takahashi
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Yoshimitsu Ishibashi
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Mikizou Nakai
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Hitoshi Suhara
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Fuminari Kasashima
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Masamitsu Endo
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Takeshi Nishina
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Jyunichi Kei
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Akihiro Mizuno
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
Nobuhiro Handa
National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm

Keywords: abdominal aortic aneurysm, EVAR, open surgery, renal function, eGFR

JOURNAL FREE ACCESS

2015 Volume 8 Issue 3 Pages 187-191

DOI https://doi.org/10.3400/avd.oa.15-00072

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Abstract

Whether endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is a relative contraindication in patients with preoperative renal dysfunction (Pre-RD), remains controversial because the contrast medium may induce nephrotoxicity. In this study 1658 patients were treated at ten Japanese medical centers between January 2005 and March 2011 (Open surgery (OS) vs. EVAR: n = 1270 vs. n = 388). They were retrospectively analyzed. Multiple logistic regression analysis (MLRA) with pre- and intra-operative variables was applied to all patients. The endpoints induced onset of new dialysis and postoperative renal dysfunction (Post-RD), were defined as a 50% decrease or more from the preoperative estimated glomerular filtration rate (eGFR) level.Results: Early mortality, Post-RD, incidence of new dialysis in all patients were 1.6% (OS: EVAR = 1.9%:0.8%), 6% (OS: EVAR = 8%:2.3%) and 1.4% (OS: EVAR = 1.5%:1.0%) respectively. MLRA identified operation time, clamp of renal artery as risk factors for Post-RD, and operation time and Pre-eGFR level as risk factors for new dialysis.Conclusion: Although Post-RD was more frequently observed in the OS group, MLRA showed that the choice of OS or EVAR was not a risk factor for Post-RD and new dialysis. It was strongly suggested that using contrast medium during EVAR is not a contraindication to AAA repair in patients with Pre-RD. (This article is a translation of J Jpn Coll Angiol 2014; 54: 13–18.)

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