Post-Operative Acute Kidney Injury following elective and emergent Snorkel Endovascular Aneurysm Repair
Jon Orlino, MS, Tareq M. Massimi, MD, Rajesh K. MALIK, MD, Misaki M. Kiguchi, MD, Edward Y. Woo, MD, Steven D. Abramowitz, MD.
MedStar Washington Hospital Center, Washington, DC, USA.
OBJECTIVE: Performing complex uni- or bilateral renal artery "snorkel" during EVAR can add additional operative time and contrast use to a case when compared to traditional EVAR. We sought to see if the additional procedural components influenced the rate of post-operative acute kidney injury (AKI) in patients undergoing sn-EVAR and to explore the factors contributing to an increased risk of AKI post-sn-EVAR. METHODS: This is a retrospective chart review of thirty-three cases of endovascular aortic repair (EVAR) with renal snorkel from February 2014 to December 2015. Baseline characteristics were recorded and post-operative AKI was determined according to RIFLE criteria. Statistical analysis was performed using the Fisher's exact test and t-test. All cases were performed in a hybrid operating room. RESULTS: Patients undergoing elective sn-EVAR experienced an incidence of AKI (11.8%) consistent with published rates for traditional EVAR. In cases considered urgent or emergent for symptomatic aneurysms or those with aneurysm rupture, the incidence of AKI was significantly higher when compared to asymptomatic and elective cases (56.3% vs 11.8%, p=0.010). The overall incidence of post-operative AKI in sn-EVAR was 33.3% (11/33). Bilateral renal snorkel was performed in 21 cases. No significant difference was found between these patients and patients who received unilateral renal snorkels (38.1% vs 25.0%, p=0.703). In addition, there were no significant associations between the incidence of AKI and gender (36.4% vs 27.3%, p=0.701), diabetes (16.7% vs 37.0%, p=0.637), hypertension (34.6% vs 28.6%, p=1.00), chronic kidney disease (50.0% vs 28.0%, p=0.392), hyperlipidemia (40.0% vs 27.8%, p=0.488), or chronic obstructive pulmonary disease (20.0% vs 39.1%, p=0.392). Patients who developed AKI had no differences in age (69.55 ± 13.12 vs 74.18 ± 9.70 yrs, p=0.259), fluoroscopy time (85.3 ± 37.6 vs 65.4 ± 25.5 min, p=0.162) or amount of administered contrast (157 ± 42 vs 152 ± 95 mL, p=0.882) compared to patients who did not develop AKI. All patients with AKI showed resolution and there was no progression in CKD classification or hemodialysis need. CONCLUSIONS: Post-operative acute kidney injury may occur at a similar rate in both elective sn-EVAR and previously published data during traditional EVAR. Surgical urgency or emergency remains the strongest predictor of AKI.
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