Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Eur J Vasc Endovasc Surg. 2021 Dec;62(6):859-868. doi: 10.1016/j.ejvs.2021.08.033. Epub 2021 Oct 27.
To review experience of fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal/thoraco-abdominal aortic aneurysms (PRAA/TAAA) and to assess the association between pre-operative moderate to severe chronic kidney disease (CKD) and post-operative outcomes.
All consecutive patients undergoing (elective and non-elective) F-BEVAR at a single centre (1 January 2011 - 1 July 2019) were identified. Renal function was calculated as the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula. Accordingly, presence of moderate to severe CKD was defined as eGFR < 60 mL/min/1.73m.
Overall, 202 consecutive patients (mean age 72 ± 8 years; 25% women) underwent F-BEVAR for the treatment of PRAA/TAAA during the study period. Of these, 51 had a history of moderate to severe CKD (none on chronic haemodialysis). No statistically significant differences were found in demographics and major comorbidities between patients with or without a history of CKD. The overall peri-operative mortality rate was 2%, without statistically significant differences between study groups (p = .26). Patients with prior CKD had statistically significantly higher rates of acute kidney injury (AKI) (37% vs. 12%, p < .001). At three years, overall survival was statistically significantly lower in patients with history of CKD compared with those without pre-operative CKD (57% vs. 82%, p = .010). Similarly, freedom from renal function decline at three years was statistically significantly poorer in patients with prior history of CKD compared with those without pre-operative CKD (43% vs. 80%, p = .020). In a multivariable analysis CKD was independently associated with higher odds of peri-operative AKI (OR 2.8, 95% CI 1.9 - 5.8, p = .030), renal function decline (OR 4.9, 95% CI 1.7 - 9.2, p = .003), and all cause mortality (HR 3.2, 95% CI 1.2 - 8.6, p = .020).
Despite low peri-operative mortality rates that are comparable to patients with unimpaired renal function, occurrence of AKI was statistically significantly higher in subjects with pre-existing moderate to severe CKD. History of CKD was independently associated to renal function decline and poorer midterm survival.
回顾腔内分支型主动脉瘤修复术（F-BEVAR）治疗肾周/胸腹主动脉瘤（PRAA/TAAA）的经验，并评估术前中重度慢性肾脏病（CKD）与术后结局之间的关系。
在一家中心（2011 年 1 月 1 日至 2019 年 7 月 1 日），我们确定了所有连续接受（选择性和非选择性）F-BEVAR 的患者。肾功能通过肾脏病饮食改良公式（MDRD）计算为估算肾小球滤过率（eGFR）。因此，中重度 CKD 的存在定义为 eGFR < 60 mL/min/1.73m。
在研究期间，共有 202 例连续患者（平均年龄 72 ± 8 岁，25%为女性）接受 F-BEVAR 治疗 PRAA/TAAA。其中，51 例有中重度 CKD 病史（无慢性血液透析患者）。有或无 CKD 病史的患者在人口统计学和主要合并症方面无统计学显著差异。总的围手术期死亡率为 2%，两组间无统计学显著差异（p =.26）。有 CKD 病史的患者急性肾损伤（AKI）发生率明显更高（37% vs. 12%，p <.001）。在 3 年时，与无术前 CKD 的患者相比，有 CKD 病史的患者的总生存率明显降低（57% vs. 82%，p =.010）。同样，与无术前 CKD 的患者相比，有 CKD 病史的患者在 3 年内肾功能下降的比例明显较低（43% vs. 80%，p =.020）。在多变量分析中，CKD 与围手术期 AKI（OR 2.8，95%CI 1.9-5.8，p =.030）、肾功能下降（OR 4.9，95%CI 1.7-9.2，p =.003）和全因死亡率（HR 3.2，95%CI 1.2-8.6，p =.020）的高风险独立相关。
尽管围手术期死亡率较低，与肾功能正常的患者相当，但在存在中重度 CKD 的患者中，AKI 的发生率明显更高。CKD 病史与肾功能下降和中期生存率降低独立相关。
