The risk of renal function deterioration in abdominal aortic stent graft patients with and without previous kidney function failure – an analysis of risk factors
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Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice
1st Department of Cardiology, Medical University of Silesia, Katowice
Submission date: 2020-04-30
Final revision date: 2020-06-11
Acceptance date: 2020-06-16
Publication date: 2020-12-15
Pol J Radiol, 2020; 85: 643-649
Kidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up.

Material and methods:
A total of 214 endovascularly treated AAA patients were included. In all cases, pre- and postope­rative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years.

The baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m2. Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endo­vascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance.

Angio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.

Mitchell AM, Jones AE, Tumlin JA, Kline JA. Incidence of contrast- induced nephropathy after contrastenhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol 2010; 5: 4-9.
McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 1997; 103: 368-375.
Srodon P, Matson M, Ham R. Contrast nephropathy in lower limb angiography. Ann R Coll Surg Engl 2003; 85: 187-191.
Gallitto E, Faggioli G, Gargiulo M, et al. Planning, execution, and follow-up for endovascular aortic aneurysm repair using a highly restrictive iodinated contrast protocol in patients with severe renal disease. Ann Vasc Surg 2018; 47: 205-221.
Crespy V, Salomon du Mont L, Kaladji A, et al. Treatment of asymptomatic abdominal aortic aneurysms in octogenarians: factors influencing long-term survival. Ann Vasc Surg 2017; 45: 199-205.
Gupta PK, Engelbert TL, Ramanan B, et al. Postdischarge outcomes after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2014; 59: 903-908.
Dariane C, Coscas R, Boulitrop C, et al. Acute kidney injury after open repair of intact abdominal aortic aneurysms. Ann Vasc Surg 2017; 39: 294-300.
Coscas R, Wagner S, Vilaine E, et al. Preoperative evaluation of the renal function before the treatment of abdominal aortic aneurysms. Ann Vasc Surg 2017; 40: 162-169.
Tang Y, Chen J, Huang K, et al. The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after abdomi­nal aortic aneurysm repair surgery. BMC Nephrol 2017; 18: 184.
Brinkman R, HayGlass KT, Mutch WA, Funk DJ. Acute kidney injury in patients undergoing open abdominal aortic aneurysm repair: a pilot observational trial. J Cardiothorac Vasc Anesth 2015; 29: 1212-1219.
Al Adas Z, Shepard AD, Nypaver TJ, et al. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2018; 68: 739-748.
Wald R, Waikar SS, Liangos O, et al. Acute renal failure after endovascular vs open repair of abdominal aortic aneurysm J Vasc Surg 2006; 43: 460-466.
Bang JY, Lee JB, Yoon Y, et al. Acute kidney injury after infrarenal abdominal aortic aneurysm surgery: a comparison of AKIN and RIFLE criteria for risk prediction. Br J Anaesth 2014; 113: 993-1000.
Roy AK, Mc Gorrian C, Treacy C, et al. A comparison of traditional and novel definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure. Cardiorenal Med 2013; 3: 26-37.
Ratanarat R, Skulratanasak P, Tangkawattanakul N, Hantaweepant C. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for predicting hospital mortality in critically ill patients with multi-organ dysfunction syndrome. J Med Assoc Thai 2013; 96 Suppl 2: 224-231.
Khamaisi M, Raz I, Shilo V, et al. Diabetes and radiocontrast media increase endothelin converting enzyme-1 in the kidney. Kidney Int 2008; 74: 91-100.
Kolonko A, Kokot F, Wiecek A. Contrast-associated nephropathy: old clinical problem and new therapeutic perspectives. Nephrol Dial Transplant 1998; 13: 803-806.
Morcos SK. Contrast media-induced nephrotoxicity – questions and answers. Br J Radiol 1998; 71: 357-365.
Rotter A. New contraindication to intravascular iodinated contrast material. Radiology 1995; 197: 545-546.
Bainey KR, Rahim S, Etherington K, et al.; CAPTAIN Investigators. Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization: results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Cardiac Catheterization (CAPTAIN) trial. Am Heart J 2015; 170: 110-116.
Lee J, Park KM, Jung S, et al. Occurrences and results of acute kidney injury after endovascular aortic abdominal repair? Vasc Specialist Int 2017; 33: 135-139.
Eggebrecht H, Breuckmann F, Martini S, et al. Frequency and outcomes of acute renal failure following thoracic aortic stent-graft placement. Am J Cardiol 2006; 98: 458-463.
de Bruin JL, Vervloet MG, Buimer MG, et al.; DREAM Study Group. Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial. Br J Surg 2013; 100: 1465-1470.
Brown LC, Brown EA, Greenhalgh RM, et al.; UK EVAR Trial Partici­pants. Renal function and abdominal aortic aneurysm (AAA): the impact of different management strategies on long-term renal function in the UK EndoVascular Aneurysm Repair (EVAR) Trials. Ann Surg 2010; 251: 966-975.
Mills JL, Duong ST, Leon LR Jr, et al. Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate. J Vasc Surg 2008; 47: 1141-1149.
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