The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Surgery, The George Washington University Hospital, Washington, DC, USA.
Vasc Endovascular Surg. 2024 Nov;58(8):825-831. doi: 10.1177/15385744241276705. Epub 2024 Aug 19.
Chronic kidney disease (CKD) has been identified as an independent predictor of poorer long-term prognosis after endovascular aneurysm repair (EVAR) for complex abdominal aortic aneurysm (AAA). However, its impact on short-term perioperative outcomes is conflicting, which can be important for preoperative risk stratification. This study aimed to evaluate the 30-day outcomes of patients with CKD following non-ruptured complex EVAR in a national registry.
Patients who had EVAR for complex AAA were identified in ACS-NSQIP targeted database from 2012-2022. Complex AAA included juxtarenal, suprarenal, or pararenal proximal extent, Type IV thoracoabdominal aneurysm, and/or aneurysms treated with Zenith Fenestrated endograft. Exclusion criteria included age<18 years, ruptured AAA, acute intraoperative conversion to open, emergency presentation, and dialysis. Multivariable logistic regression was used to compare 30-day postoperative outcomes of CKD and non-CKD patients, where demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures were adjusted.
There were 695 (39.33%) and 1072 (60.67%) patients with and without CKD, respectively, who underwent EVAR for complex AAA. Patients with and without CKD have comparable 30-day mortality (aOR = 1.165, 95 CI = 0.646-2.099, = 0.61). However, CKD patients had a higher risk of renal complications (aOR = 2.647, 95 CI = 1.399-5.009, < 0.01) including higher progressive renal insufficiency (aOR = 3.707, 95 CI = 1.329-10.338, = 0.01) and acute renal failure requiring renal replacement therapy (aOR = 2.533, 95 CI = 1.139-5.633, = 0.02). All other 30-day outcomes were comparable between CKD and non-CKD patients.
Patients with CKD had similar 30-day mortality and morbidity rates but a higher risk of postoperative renal complications. Therefore, meticulous preoperative planning and postoperative management, which may include optimal hydration, appropriate contrast use, and close renal function monitoring, are essential for patients with CKD after complex EVAR.
慢性肾脏病（CKD）已被确定为腹主动脉瘤（AAA）腔内修复术（EVAR）后长期预后较差的独立预测因素。然而，其对短期围手术期结果的影响存在争议，这对于术前风险分层很重要。本研究旨在评估全国登记处中 CKD 患者接受非破裂性复杂 EVAR 后的 30 天结局。
从 2012 年至 2022 年，ACS-NSQIP 靶向数据库中确定了接受复杂 AAA EVAR 的患者。复杂 AAA 包括肾旁、肾上或肾周近端范围、IV 型胸腹主动脉瘤和/或使用 Zenith Fenestrated 支架的动脉瘤。排除标准包括年龄<18 岁、AAA 破裂、术中急性转为开放、紧急就诊和透析。多变量逻辑回归用于比较 CKD 和非 CKD 患者的 30 天术后结局，调整了人口统计学、基线特征、动脉瘤直径、远处动脉瘤范围、麻醉和伴随手术。
分别有 695 例（39.33%）和 1072 例（60.67%）患者患有 CKD 和非 CKD，并接受了复杂 AAA 的 EVAR。CKD 患者和非 CKD 患者的 30 天死亡率相当（aOR=1.165，95%CI=0.646-2.099，=0.61）。然而，CKD 患者发生肾脏并发症的风险更高（aOR=2.647，95%CI=1.399-5.009，<0.01），包括进展性肾功能不全（aOR=3.707，95%CI=1.329-10.338，=0.01）和需要肾脏替代治疗的急性肾衰竭（aOR=2.533，95%CI=1.139-5.633，=0.02）。CKD 患者和非 CKD 患者的所有其他 30 天结局均相当。
CKD 患者的 30 天死亡率和发病率相似，但术后肾脏并发症的风险更高。因此，对于接受复杂 EVAR 的 CKD 患者，术前需要精心计划和术后管理，包括最佳水化、适当使用造影剂和密切监测肾功能。
