Risk Factors for Acute Renal Failure After Endovascular Aneurysm Repair

• Published in: The American surgeon Vol. 90; no. 1; p. 55
• Main Authors: Zambetti, Benjamin R, Zickler, William P, Byerly, Saskya, Garrett, Jr, H Edward, Magnotti, Louis J
• Format: Journal Article
• Language: English
• Published: United States 01.01.2024
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation - adverse effects; Endovascular Aneurysm Repair; Endovascular Procedures - adverse effects; Female; Humans; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Treatment Outcome; renal; EVAR; acute kidney injury; vascular surgery
• ISSN: 1555-9823
• DOI: 10.1177/00031348231191181

Acute kidney injury (AKI) after endovascular aortic aneurysm repair (EVAR) is uncommon though carries significant morbidity. Procedural risk factors are not well established for acute renal failure (ARF) that requires initiation of dialysis. The goal of this study was to examine the impact of ARF on patients undergoing EVAR and identify risk factors for ARF using a large, national dataset. Patients undergoing EVAR were identified from the National Surgical Quality Improvement Program (NSQIP) database over 9 years, ending in 2019. Demographics, indication for repair, comorbidities, procedural details, complications, hospital and ICU LOS, and mortality were recorded. Patients were stratified by presence of ARF and compared. Patients were further stratified by indication for EVAR and presence of ARF. Multivariable logistic regression (MLR) analysis was performed to determine the independent predictors of ARF. 18 347 patients were identified. Of these 234 (1.3%) developed ARF requiring dialysis. Mortality (40 vs 1.8%, < .0001), ICU LOS (5 vs 0 days, < .0001), and hospital LOS (11 vs 2 days, < .0001) were all significantly increased in patients with ARF. Multivariable logistic regression identified increasing diameter, creatinine, operative time, preoperative transfusions, ASA class, emergent repair, female gender, and juxtarenal/suprarenal proximal landing zone as predictors of ARF. ARF after EVAR causes significant morbidity, prolongs hospitalizations, and increases mortality rates. Those patients at risk of ARF after EVAR should be closely monitored to reduce both morbidity and mortality.