Wald Ron, Waikar Sushrut S, Liangos Orfeas, Pereira Brian J G, Chertow Glenn M, Jaber Bertrand L
Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
J Vasc Surg. 2006 Mar;43(3):460-466; discussion 466. doi: 10.1016/j.jvs.2005.11.053.
Endovascular aneurysm repair (EVAR) is an increasingly used alternative to open surgical repair of unruptured abdominal aortic aneurysms (AAAs). The effect of EVAR on postprocedure acute renal failure has not been determined. We hypothesized that EVAR would be associated with a lower risk of acute renal failure and acute renal failure requiring hemodialysis.
A retrospective cohort study was conducted of the 2002 Nationwide Inpatient Sample, the largest all-payer inpatient care database in the United States, reflecting discharges from a representative sample of United States hospitals. We identified 6614 discharges with a primary diagnosis of unruptured AAA and a primary procedure code for open AAA repair or EVAR. We excluded 56 patients with end-stage renal disease and 42 patients who underwent concomitant aortorenal bypass. We compared EVAR vs open repair in this cohort. The main outcome measures were acute renal failure and acute renal failure requiring dialysis.
A total of 6516 patient discharges met the inclusion criteria for the study, and postprocedure acute renal failure developed in 439 (6.7%). EVAR was associated with lower odds of acute renal failure (adjusted odds ratio, 0.42; 95% confidence interval, 0.33 to 0.53) and acute renal failure requiring dialysis (adjusted odds ratio, 0.30, 95% confidence interval, 0.15 to 0.63). Results were similar when EVAR and open AAA repair were compared within quintiles of the propensity score for the receipt of EVAR.
Compared with open AAA repair, EVAR is associated with a lower risk of postprocedure acute renal failure.
血管内动脉瘤修复术（EVAR）是未破裂腹主动脉瘤（AAA）开放手术修复术越来越常用的替代方法。EVAR对术后急性肾衰竭的影响尚未确定。我们假设EVAR与急性肾衰竭及需要血液透析的急性肾衰竭风险较低相关。
对2002年全国住院患者样本进行回顾性队列研究，该样本是美国最大的全付费者住院护理数据库，反映了美国医院代表性样本的出院情况。我们确定了6614例主要诊断为未破裂AAA且主要手术编码为开放AAA修复术或EVAR的出院病例。我们排除了56例终末期肾病患者和42例接受同期主动脉肾动脉旁路移植术的患者。我们在该队列中比较了EVAR与开放修复术。主要结局指标为急性肾衰竭和需要透析的急性肾衰竭。
共有6516例患者出院符合研究纳入标准，术后发生急性肾衰竭的有439例（6.7%）。EVAR与急性肾衰竭（调整比值比，0.42；95%置信区间，0.33至0.53）及需要透析的急性肾衰竭（调整比值比，0.30，95%置信区间，0.15至0.63）的较低几率相关。在接受EVAR倾向评分的五分位数内比较EVAR和开放AAA修复术时，结果相似。
与开放AAA修复术相比，EVAR与术后急性肾衰竭风险较低相关。
