Display options
Share it on

Eur Radiol. 2016 Jun;26(6):1613-9. doi: 10.1007/s00330-015-3993-8. Epub 2015 Oct 02.

Endovascular treatment of complex aortic aneurysms: prevalence of acute kidney injury and effect on long-term renal function.

European radiology

Anna M Sailer, Patricia J Nelemans, Camille van Berlo, Ozan Yazar, Michiel W de Haan, Dominik Fleischmann, Geert Willem H Schurink

Affiliations

  1. Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. [email protected].
  2. Department of Radiology, Stanford University Hospitals and Clinics, Stanford, CA, USA. [email protected].
  3. Department of Epidemiology, Maastricht University Medical Centre, Maatsricht, The Netherlands.
  4. Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
  5. Department of Vascular Surgery, Cliniques del Europe, Brussels, Belgium.
  6. Department of Radiology, Stanford University Hospitals and Clinics, Stanford, CA, USA.
  7. Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.

PMID: 26431707 PMCID: PMC4863901 DOI: 10.1007/s00330-015-3993-8

Abstract

OBJECTIVES: To analyse predictors for short- and long-term renal function changes after fenestrated and branched endovascular aortic repair (EVAR).

METHODS: A total of 157 patients underwent fenestrated and branched EVAR. Procedural intra-arterial iodinated contrast volume was documented. Serum creatinine and estimated glomerular filtration rate (eGFR) at baseline, during 48 h following EVAR, at discharge and latest moment of follow-up were recorded. Development of post-EVAR acute kidney injury (AKI; according to AKIN criteria), and potential risk factors for renal failure were recorded. Multivariate regression analyses were used to identify independent risk factors for AKI and eGFR decrease during follow-up.

RESULTS: Forty-three patients (28 %) developed post-EVAR AKI. Long procedure time and occlusion of accessory renal arteries were independent risk factors for development of AKI. (odds ratio (OR) 1.005 per minute, 95 % CI 1.001-1.01; p = 0.025 and OR 3.02, 95 % CI 1.19-8.16; p = 0.029). Post-EVAR AKI was associated with a significantly increased risk for eGFR decrease at discharge and latest follow-up (hazard ratio (HR) 3.47, 95 % CI 1.63-7.36, p = 0.001 and HR 3.01, 95 % CI 1.56-5.80; p = 0.001). Iodinated contrast volume was not an independent risk factor for AKI or eGFR decrease during follow-up.

CONCLUSION: Development of post-EVAR AKI is an independent risk factor for long-term renal function decrease.

KEY POINTS: • Longer procedure time is associated with an increased risk for AKI. • Renal perfusion defects on angiography are associated with increased risk for AKI. • Post-EVAR AKI is associated with higher probability for long-term eGFR decrease. • Iodinated contrast volume is not an independent risk factor for AKI. • Iodinated contrast volume is not an independent risk factor for long-term eGFR decrease.

Keywords: Acute kidney injury; Aortic aneurysm; Contrast media; Endovascular procedures; Glomerular filtration rate

References

  1. J Vasc Surg. 2009 Oct;50(4):880-96 - PubMed
  2. AJR Am J Roentgenol. 2008 Aug;191(2):383-6 - PubMed
  3. Radiology. 2010 Jul;256(1):21-8 - PubMed
  4. Eur Radiol. 2011 Dec;21(12):2527-41 - PubMed
  5. J Vasc Surg. 2012 Aug;56(2):291-6; discussion 296-7 - PubMed
  6. Radiology. 2013 Apr;267(1):106-18 - PubMed
  7. Crit Care Med. 2013 Apr;41(4):1017-26 - PubMed
  8. Eur Radiol. 2013 May;23(5):1260-3 - PubMed
  9. Eur J Cardiothorac Surg. 2013 Aug;44(2):e156-63; discussion e163 - PubMed
  10. Eur J Vasc Endovasc Surg. 2014 Apr;47(4):349-56 - PubMed
  11. Radiology. 2013 Oct;269(1):92-100 - PubMed
  12. Radiology. 2013 Sep;268(3):719-28 - PubMed
  13. AJR Am J Roentgenol. 2014 Apr;202(4):784-9 - PubMed
  14. Eur Radiol. 2014 May;24(5):1105-11 - PubMed
  15. J Vasc Surg. 2014 Sep;60(3):563-70 - PubMed
  16. J Vasc Surg. 2014 Sep;60(3):597-603 - PubMed
  17. J Vasc Surg. 2015 Jan;61(1):256-64 - PubMed
  18. Kidney Int. 2015 Feb;87(2):442-51 - PubMed
  19. Eur J Vasc Endovasc Surg. 2015 May;49(5):524-31 - PubMed
  20. Eur Radiol. 2015 Aug;25(8):2274-81 - PubMed
  21. Circulation. 2006 Apr 11;113(14):1799-806 - PubMed
  22. Ann Intern Med. 2006 Aug 15;145(4):247-54 - PubMed
  23. Crit Care. 2007;11(2):R31 - PubMed
  24. Clin J Am Soc Nephrol. 2008 May;3(3):844-61 - PubMed
  25. J Vasc Surg. 2008 May;47(5):1094-1098 - PubMed
  26. N Engl J Med. 2010 May 20;362(20):1863-71 - PubMed

Substances

MeSH terms

Publication Types