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

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 10 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 eGFR level. Results: Early mortality, Post-RD, incidence and 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. Using contrast medium during EVAR often may not be a contraindication to AAA repair in patients with Pre-RD.