Aim: Surgical outcome of abdominal aortic aneurysm repair in high-risk patients with complications are poor. The purpose of this paper is to study the surgical outcome of abdominal aortic aneurysm repair in patients with chronic renal dysfunction. Method: Patients undergoing elective abdominal aortic aneurysm repair from 1991 to 2006 (n = 306) were divided into 2 groups, according to their preoperative serum creatinine levels: >1.3 mg/dl (group H, n = 46) and <1.3 mg/dl (group L, n = 260). These patients were analyzed retrospectively. Results: The preoperative incidence of coronary artery disease was significantly higher in group H (53.6%) than in group L (31.4%, p = 0.0054), and with multi-vessel disease was also significantly higher in group H (48.8%) than in group L (20.1%, p = 0.021). The mortality rate of group H (4.3%) was significantly higher than in group L (0.9%, p = 0.049). Two patients in group H, one patient with non-occlusive mesenteric ischemia and one with ischemic colitis, both of whom required urgent operation, had multiple organ failure and died in the perioperative period. There was no difference of intra-operative blood loss between the groups, but the amount of blood transfusion in group L was significantly lower (p = 0.015). Group H patients had a longer median length of hospital and ICU stay. Conclusion: The incidence of preoperative coronary artery disease, especially with multi-vessel disease, in patients undergoing abdominal aortic aneurysm repair with renal dysfunction was significantly higher. The mortality rate among these patients was also higher than those with normal renal function. Preoperative screening should be stressed and intraoperative and postoperative management should be carefully performed appropriately.

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