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Effects Of Renal Dysfunction On Mortality After Endovascular Aortic Repair
Flora S. Park1, Josephine E. Chang, BS
1, Shannen Guarina, BS
1, Roy M. Fujitani, MD
2, Nii K. Kabutey, MD
2, Isabella J. Kuo, MD
2, Samuel L. Chen, MD
2, Anthony H. Chau, MD
2.
1University of California, Irvine School of Medicine, Irvine, CA, USA,
2Division of Vascular and Endovascular Surgery, University of California, Irvine, Orange, CA, USA.
OBJECTIVES: This study aims to elucidate the influence of perioperative acute kidney injury (AKI) and chronic kidney disease (CKD) on immediate and long-term mortality in patients undergoing elective and emergent endovascular repair of the abdominal and thoracic aorta (EVAR/TEVAR).
METHODS: Retrospective chart review was performed for
>18-years-old patients who had EVAR/TEVAR at an academic medical center from January 2012 to December 2021. Data collected included patient demographics, preoperative CKD stage, presence of perioperative AKI, and short-term (30-day) and long-term mortality. Chi square test, univariate logistic regression, and Kaplan-Meier curves for the outcome variables were analyzed.
RESULTS: In the study cohort of 155 patients, 73 patients (47.1%) had EVAR and 82 patients (52.9%) had TEVAR for aortic etiologies including degenerative aneurysms, aortic dissection, and aortic rupture. 62 patients (40.0%) had preoperative CKD. 25 patients (16.1%) were diagnosed with preoperative AKI and 36 (23.4%) with new-onset postoperative AKI. Mean follow-up time was 10.5 (0-105) months. The presence of preoperative CKD stages 3-5 was significantly associated with worse long-term survival, with CKD stage 5 patients less likely to survive than CKD stage 3-4 patients (Fig 1) (p=0.04). Preoperative AKI was also associated with worse survival (p= 0.02) and an increase in both short-term (OR=4.41, CI 1.32-14.8) and long-term mortality risk (OR=2.94, CI 1.18-7.35). Similarly, Postoperative AKI was associated with worse survival (p=0.0003) and an increase in both short-term (OR=7.33, CI 2.16-24.9) and long-term mortality (OR=3.55, CI 1.57-8.06).
CONCLUSIONS: Perioperative renal dysfunction, notably pre-operative advanced stage CKD (stages 3-5) and perioperative AKI, appears to be a strong predictor of short-term and long-term mortality after EVAR/TEVAR. Renal dysfunction should be carefully managed during preoperative case planning, risk assessment and be incorporated as part of the informed consent.
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