Renal function-adjusted contrast medium volume is a major risk factor in the occurrence of acute kidney injury after endovascular aneurysm repair

Kidney Function, Male Gender, and Aneurysm Diameter Are Predictors of Acute Kidney Injury in Patients with Abdominal Aortic Aneurysms Treated Endovascularly

Abdominal aortic aneurysm (AAA) is a degenerative disease of the aortic wall with potentially fatal complications. The widespread adoption of endovascular aneurysm repair (EVAR), which is less invasive and equally (if not more) effective for abdominal aortic aneurysms (AAA), is due to the obvious advantages of the procedure compared to the traditional open repair. As the popularity of endovascular procedures grows, related complications become more evident, with kidney damage being one of them. Although acute kidney injury following EVAR is relatively common, its true incidence is still uncertain. The purpose of this study was to assess the incidence of acute kidney injury among patients treated with endovascular repair of ruptured AAA. In addition, we aimed to determine the predictors of PC-AKI in patients with abdominal aortic aneurysm treated with EVAR.

PATIENTS AND METHODS

We retrospectively analyzed a prospective registry of abdominal aortic aneurysm of 247 patients operated endovascularly at a single center between 2015 and 2021. Due to a lack of clinical data, data of 192 patients were reviewed for postcontrast acute kidney injury. Additional comorbidities were included in this study: hypertension, diabetes mellitus, atrial fibrillation, chronic coronary syndrome, COPD, and chronic kidney disease. Follow-up examinations were performed before the procedure and 48 h after contrast administration.

RESULTS

The group of 36 patients developed PC-AKI, which is 19% of the entire study population. Hypertension, diabetes, chronic kidney disease, male gender, and incidence of PC-AKI were more prevalent in patients with higher aortic aneurysm diameter ≥67 mm. In multiple regression analyses, independent predictors of PC-AKI were serum creatinine, chronic kidney disease, male gender, and aortic aneurysm diameter ≥67 mm.

CONCLUSIONS

One of the major complications after EVAR is acute kidney injury, which is linked to higher death and morbidity rates. Independent risk factors for postcontrast acute kidney injury were chronic kidney disease, male gender, and aortic diameter. Only aortic diameter could be modifiable risk factor, and earlier surgery could be considered to yield better outcomes. More research is critically needed to determine how AKI affects long-term outcomes and to look at preventive options.

A simplified acute kidney injury predictor following endovascular aortic repair: ACEF score

OBJECTIVES

Treatment of abdominal aortic aneurysms (AAA) with endovascular aortic repair (EVAR) has become quite common in recent years. This method, which has many advantages compared to the open surgical procedure, also has some complications. One of these complications is acute kidney injury (AKI). ACEF (age, creatinine, and ejection fraction) score, which is gaining popularity, can be an easy-to-use and cost-effective method in detecting this condition that causes increased morbidity and mortality. We aimed to evaluate whether this ACEF score may predict a development of AKI in patients who underwent EVAR.

METHODS

A total of 133 consecutive patients with AAA who underwent EVAR were analyzed. The primary endpoint of the study was the development of AKI. The best cut-off value for the ACEF score to predict the development of AKI was calculated and according to this value, the patients were divided into two groups as those with high ACEF scores and those with low ACEF scores. ACEF score was calculated by the formula of age/EF + 1 (if baseline creatinine > 2 mg/dL).

RESULTS

After the exclusion criteria, a total of 118 patients were included in the study, and 20 (16.9%) of them developed AKI after EVAR. In the ROC curve analysis, a cut-off value of 1.34 was found for the ACEF score, and scores above this value were found to be independent predictors of AKI development after EVAR. In addition to the ACEF score, the contrast media volume was also found to be an independent predictor of the development of AKI.

CONCLUSION

In conclusion, ACEF is a simple and effective scoring system in patients undergoing EVAR. To the best our knowledge, our study is the first study which applies ACEF score to predict AKI in EVAR patients.

Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

BACKGROUND

Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA); however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures.

METHODS

This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed.

RESULTS

A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5% vs . 80.9%; χ 2  = 4.10; P  = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06; 95% CI: 1.43-17.95; P  = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60; 95% CI: 1.17-5.76; P  = 0.019), and short neck (OR, 2.85; 95% CI: 1.08-7.52; P  = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups ( P  > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair.

CONCLUSIONS

Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.

Unusual Endovascular Treatment of Iliac Occlusive Disease With a Physician-Modified Endograft to Preserve a Transplant Renal Artery

PURPOSE

We describe the feasibility and early results of iliac stenting using a physician-modified endograft (PMEG) to preserve a transplant renal artery in patient with iliac occlusive disease.

CASE REPORT

A 70-year-old male patient, with sub-occlusive left common iliac artery stenosis at the level of the transplanted kidney arterial anastomosis, presented with left critical limb ischemia (CLI) and pseudo-transplant renal artery stenosis (pseudo-TRAS) symptoms. He was treated with a physician-modified fenestrated covered stent introduced percutaneously via ipsilateral femoral artery after failure of simple angioplasty (percutaneous transluminal angioplasty, PTA). The modified graft was created by performing a square fenestration graftotomy on a Medtronic iliac limb stent graft (Medtronic Cardiovascular, Santa Rosa, CA, USA). The procedure was technically successful with no intraoperative complications. Procedural time was 110 minutes, including 35 minutes for device modification. On short-term follow-up, the patient had early improvement of renal function and resolution of CLI. The iliac and transplant renal artery remained patent with no sign of stent migration or kinking on 6 months surveillance computed tomography angiography and 1 year color Doppler ultrasonography.

CONCLUSION

Use of PMEG to preserve visceral branches in occlusive iliac disease is a feasible endovascular technique with encouraging technical success and satisfying early results.