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Aortic Aneurysm Procedural Factors Implicated in Post-operative Renal Failure
Background:
As of yet small case-series were limited in their ability to estimate adjusted risk for renal failure following aortic surgery. This study hypothesized that new operative details would impact renal failure risk after both endovascular abdominal aortic aneurysm repair (EVAR), and open abdominal aortic aneurysm repair (OAR).
Methods:
The Abdominal Aortic Repair procedure targeted NSQIP dataset for 2011-2012 was analyzed using bivariate analysis to identify factors associated with post-operative renal failure measured at 30-days. Factors meeting p<0.1 were assessed for inclusion in a manual stepwise binary logistic multivariable model with the primary endpoint of post-operative renal failure. Variables that met final criteria of p<0.05 were retained in final analysis.
RESULTS:
In total 2,785 EVAR and 949 OAR cases were included. Renal failure was identified in 1.9% (n=52) of EVAR and 9.2% (n=87) in OAR (p<0.001). Significant procedure details on multivariable analysis within the EVAR group included iliac-branched devices (OR=2.32), and renal stenting (OR=2.73)(Table). Significant procedure details on multivariable analysis within the OAR group were presentation with hypotensive rupture (OR 39.72), supraceliac clamping (OR=2.21), and renal revascularization (OR=2.09)(table). On combined multivariable analysis OAR had an adjusted 3.69 times the risk for renal failure compared to EVAR.
Conclusion:
This study for the first time reports a nationally representative adjusted risk for renal failure using procedure specific data. These data confirm the dismal renal prognosis in hypotensive patient’s undergoing open repair of rupture aortic aneurysm, with a 40-fold risk for renal failure. The associated harm with adjunctive renal stenting in EVAR raises concern and demands attention given the increasing trend towards complex EVAR suggesting renal dysfunction may also become more prevalent with complex fenestrated approaches.

EVAR	Odds Ratio	Confidence Interval	P-Value
Preoperative Creatinine	1.50	1.23-1.83		<0.001
Preoperative Sepsis	3.15	1.36-7.30		0.007
ASA IV/V	2.19	1.14-4.21		0.019
Non-Elective	4.59	2.32-9.07		<0.001
Iliac-Branched Device	2.32	1.15-4.66		0.018
Renal Stent	2.73	1.16-6.41		0.022
OPEN
Anemia	1.96	1.06-3.66		0.033
Obesity(BMI>/=30)	2.46	1.46-4.15		0.001
Preoperative Creatinine	1.65	1.22-2.23		0.001
Presenting with Rupture and hypotension	39.72	2.53-624.70		0.009
ASA IV/V	2.13	1.19-3.82		0.011
Non-Elective	3.01	1.67-5.43		<0.001
Renal Revascularization	2.09	1.05-4.16		0.035
Supraceliac Clamp	2.21	1.23-3.97		0.008