Dong Siwei, An Crystal, Caputo Francis J, Lyden Sean P, Kirksey Levester, Quatromoni Jon, Rowse Jarrad W
Department of Vascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH.
Department of Vascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH.
Ann Vasc Surg. 2024 Jan;98:102-107. doi: 10.1016/j.avsg.2023.05.038. Epub 2023 Jul 7.
Complex open abdominal aortic aneurysm (AAA) repair often necessitates revascularization of renal arteries by either renal artery reimplantation or bypass. This study aims to evaluate the perioperative and short term outcomes between these 2 strategies of renal artery revascularization.
We performed a retrospective review of patients who underwent open AAA repair from 2004 to 2020 at our own institution. Patients who underwent elective suprarenal, juxtarenal, or type 4 thoracoabdominal aneurysm repair were identified using current procedural terminology (CPT) codes and a retrospectively maintained database of AAA patients. Patients who had symptomatic aneurysm or significant renal artery stenosis before AAA repair were excluded. Patient demographics, intraoperative conditions, renal function, bypass patency, and perioperative and postoperative outcomes at 30 days and 1 year were compared.
One hundred and forty-three patients underwent either renal artery reimplantation (n = 86) or bypass (n = 57) during this time period. The mean age was 69.7 years and 76.2% of the patients were male. Median preoperative creatinine was 1.2 mg/dL for the renal bypass group versus 1.06 mg/dL for reimplantation (P = 0.088). Both groups had similar median preoperative glomerular filtration rate (GFR) of >60 mL/min (P = 0.13). Bypass and reimplantation groups had similar perioperative complications including acute kidney injury (51.8% vs. 49.4% P = 0.78), inpatient dialysis (3.6% vs. 1.2% P = 0.56), myocardial infarction (1.8% vs. 2.4% P = 0.99), and death (3.5% vs. 4.7% P = 0.99), respectively. During the 30-day follow-up period, renal artery stenosis was identified in 9.8% of bypasses and 6.7% of reimplantations (P = 0.71). Six point one percent of patients in the bypass group had renal failure requiring dialysis (both acute and permanent) compared to 1.3% in reimplantation group (P = 0.3). For those who had 1-year follow-up, the reimplantation group had higher new incidence of renal artery stenosis compared to bypass group (6 vs. 0 P = 0.16).
Given that there is no significant difference in outcomes between renal artery reimplantation and bypass within 30 days or at 1-year follow-up, both bypass and reimplantation are acceptable means for renal artery revascularization during elective AAA repair.
复杂开放性腹主动脉瘤（AAA）修复术通常需要通过肾动脉再植术或旁路移植术实现肾动脉血运重建。本研究旨在评估这两种肾动脉血运重建策略的围手术期及短期结局。
我们对2004年至2020年在我院接受开放性AAA修复术的患者进行了回顾性研究。使用当前手术操作术语（CPT）编码和AAA患者回顾性维护数据库，确定接受择期肾上、肾旁或4型胸腹主动脉瘤修复术的患者。排除AAA修复术前有症状性动脉瘤或严重肾动脉狭窄的患者。比较患者的人口统计学特征、术中情况、肾功能、旁路通畅情况以及30天和1年时的围手术期及术后结局。
在此期间，143例患者接受了肾动脉再植术（n = 86）或旁路移植术（n = 57）。平均年龄为69.7岁，76.2%的患者为男性。肾旁路移植组术前肌酐中位数为1.2 mg/dL，再植术组为1.06 mg/dL（P = 0.088）。两组术前肾小球滤过率（GFR）中位数相似，均>60 mL/min（P = 0.13）。旁路移植组和再植术组围手术期并发症相似，包括急性肾损伤（51.8%对49.4%，P = 0.78）、住院透析（3.6%对1.2%，P = 0.56）、心肌梗死（1.8%对2.4%，P = 0.99）和死亡（3.5%对4.7%，P = 0.99）。在30天随访期内，旁路移植术中有9.8%发现肾动脉狭窄，再植术中有6.7%发现肾动脉狭窄（P = 0.71）。旁路移植组6.1%的患者出现需要透析的肾衰竭（包括急性和永久性），再植术组为1.3%（P = 0.3）。对于有1年随访的患者，再植术组肾动脉狭窄的新发病率高于旁路移植组（6例对0例，P = 0.16）。
鉴于肾动脉再植术和旁路移植术在30天内或1年随访时的结局无显著差异，旁路移植术和再植术都是择期AAA修复术中肾动脉血运重建的可接受方法。
