Chung Byeoung-Hoon, Kang Ji-Hee, Heo Seon-Hee, Park Yang-Jin, Kim Young-Wook, Woo Shin-Young, Kim Dong-Ik
Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Vasc Surg. 2020 Jan;62:232-237. doi: 10.1016/j.avsg.2019.02.035. Epub 2019 May 7.
Open surgery of abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD) sometimes requires left renal vein division (LRVD) to gain adequate exposure of the abdominal aorta. The aim of this study is to evaluate the effect of LRVD on the postoperative renal function using propensity score matching (PSM).
From July 1996 to January 2018, we retrospectively reviewed 698 patients who underwent open aortic surgery, including 543 AAAs and 155 AIODs, at a single institution. 66 patients (9.6%, 47 AAAs, 19 AIODs) needed LRVD during the operation. A 1:3 ratio PSM was used to control the selective bias between the LRVD and non-LRVD groups. We investigated preoperative and postoperative renal function including serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR, mL/min/1.73 m). Major complications, long-term renal function, and 30-day mortality were also compared.
The LRVD group had a significantly higher rate of renal artery reconstruction (15.2% vs. 3.3%, P < 0.001) and suprarenal clamping (54.6% vs. 9.5%, P < 0.001) and higher incidence of juxtarenal AIOD (24.2% vs. 5.4%, P < 0.001). With PSM, 63 patients in the LRVD group and 144 patients in the non-LRVD group were enrolled in this study. The baseline characteristics were well balanced in the groups after PSM. There were no significant differences in preoperative eGFR (72.4 ± 21.3 vs. 76.1 ± 25.0, P = 0.306) and postoperative eGFR on day 3 (69.5 ± 26.6 vs. 77.5 ± 28.5, P = 0.065), day 7 (73.3 ± 24.8 vs. 78.5 ± 27.4, P = 0.264), and in the long-term follow-up period (69.0 ± 22.2 vs. 68.9 ± 27.1, P = 0.986, 50.2 month ± 45.50) in the 2 groups. Only the sCr level (1.40 ± 0.59 vs. 1.21 ± 0.62, P = 0.045) and eGFR (59.5 ± 23.9 vs. 71.4 ± 26.0, P = 0.002) were significantly worse on postoperative day 1 in the LRVD than in the non-LRVD group. There were no significant differences in 30-day mortality (1.6% vs. 1.6%, P = 1.00).
The patients in the LVRD group underwent initial drop in renal function; however, eGFR improved during the follow-up period. There was no difference in renal function and postoperative mortality between LRVD and non-LRVD groups. Therefore, LRVD is a safe and durable procedure during complex abdominal aortic surgery.
腹主动脉瘤（AAA）或主-髂动脉闭塞性疾病（AIOD）的开放手术有时需要切断左肾静脉（LRVD）以充分暴露腹主动脉。本研究旨在使用倾向评分匹配（PSM）评估LRVD对术后肾功能的影响。
1996年7月至2018年1月，我们回顾性分析了在单一机构接受开放主动脉手术的698例患者，包括543例AAA和155例AIOD。66例患者（9.6%，47例AAA，19例AIOD）在手术中需要进行LRVD。采用1:3的PSM来控制LRVD组和非LRVD组之间的选择偏倚。我们调查了术前和术后的肾功能，包括血清肌酐（sCr）水平和估算肾小球滤过率（eGFR，mL/min/1.73m²）。还比较了主要并发症、长期肾功能和30天死亡率。
LRVD组肾动脉重建率（15.2%对3.3%，P<0.001）、肾上腹主动脉阻断率（54.6%对9.5%，P<0.001）显著更高，近肾型AIOD的发生率也更高（24.2%对5.4%，P<0.001）。通过PSM，LRVD组63例患者和非LRVD组144例患者纳入本研究。PSM后两组的基线特征均衡。两组术前eGFR（72.4±21.3对76.1±25.0，P=0.306）、术后第3天eGFR（69.5±26.6对77.5±28.5，P=0.065）、第7天eGFR（73.3±24.8对78.5±27.4，P=0.264）以及长期随访期（69.0±22.2对68.9±27.1，P=0.986，平均50.2个月±45.50）均无显著差异。仅术后第1天LRVD组的sCr水平（1.40±0.59对1.21±0.62，P=0.045）和eGFR（59.5±23.9对71.4±26.0，P=0.002）显著差于非LRVD组。30天死亡率无显著差异（1.6%对1.6%，P=1.00）。
LRVD组患者术后肾功能最初下降；然而，随访期间eGFR有所改善。LRVD组和非LRVD组在肾功能和术后死亡率方面无差异。因此，LRVD在复杂腹主动脉手术中是一种安全且持久的手术方式。
