Abstract
Objectives: In recent years, endovascular aortic repair (EVAR) of aortic aneurysms has become more widespread, but in cases of chronic kidney disease, there are few case reports concerning the impact of EVAR and graft replacement (GR) on renal function when utilized in conjunction with a contrast medium. We report a comparison of postoperative renal function in EVAR and GR patients. Methods: From August 2008 to October 2009, 25 patients (23 men, 2 women) underwent elective EVAR and the same number underwent elective GR. Dialysis patients were excluded from this study. All abdominal aortic aneurysms were of the infrarenal type. In cases in which EVAR was indicated, we selected EVAR regardless of renal function. In the GR group, all cases underwent clamping beneath the renal artery. In cases of chronic kidney disease which received EVAR, we performed preoperative and the postoperative hydration and controlled the amount of the contrast medium used, which ranged from 40 cc to 50 cc in EVAR patients. Based on estimated glomerular filtration rate (eGFR), we categorized chronic kidney disease (CKD) stage according to the guidelines of the Japanese Nephrology Society. We then compared the preoperative and the postoperative values. The eGFR levels naturally decreased, we considered a reduction beyond a postoperative eGFR value of 20% to be significant. Results: A difference in CKD stage was observed between the preoperative and postoperative (preoperative vs. postoperative) values in the EVAR group in stage 1 = (1:2), stage 2 = (15:14), stage 3 = (5:6), stage 4 = (4:2), and stage 5 = (0:1). Only 1 case showed deterioration preoperatively (4%). On the other hand, differences in pre- and postoperative values in the GR group were observed in stage 1 = (3:19), stage 2 = (4:7), stage 3 = (16:13), stage 4 = (2:4), but not in stage 5 = (0:0). A total of 6 cases in this group showed deterioration preoperatively (24%). Moreover, the number of cases in which the eGFR decreased, but which did so by not less than 20% of the postoperative value, was 2 in the EVAR group (8%), and 6 (24%) in the GR group. Conclusion: Even in cases of renal insufficiency, EVAR can be performed using pre- and postoperative hydration, and by minimizing the amount of the contrast medium used.
