Abstract
Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) is becoming the predominant technique compared with open repair (OR). However, limited data are available regarding the effect of EVAR on renal function. We studied the characteristics of acute kidney injury (AKI) in EVAR and OR. We retrospectively investigated 147 adults who underwent infrarenal AAA surgery (EVAR; 70, OR; 77) from 2006 to 2008. We analyzed the incidence and outcomes of AKI following AAA surgery. AKI was diagnosed according to the RIFLE criteria, which was defined as the maximum postoperative increase in serum creatinine level from the preoperative baseline ( ΔsCr). In the EVAR group, we observed that the patients were older and that the duration of operation, mechanical ventilation, ICU and hospital stay, fluids and blood products requirements, use of diuretics and cross clamping of the renal artery were significantly less than the OR group. However, there was no significant difference in the incidence of postoperative AKI between the two groups (P = 0.28). Neither hospital mortality nor the requirements for postoperative renal replacement therapy were significantly different. The preoperative sCr level was significantly higher in the EVAR group. The period that the ΔsCr was over 0.5 mg/dl was significantly longer in the EVAR group. In the comprehensive risk analysis in the both of EVAR and OR groups, intraoperative cross clamping of the renal artery increases the risk of AKI by 5 folds, and postoperative AKI increases the risk of postoperative mechanical ventilation by 6 folds. While AKI occurred at a similar frequency after either EVAR or OR, EVAR-AKI was more prolonged than OR-AKI. This is likely due to the advanced age and renal dysfunction in the EVAR group.
