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The Journal of Cardiovascular Surgery 2021 February;62(1):42-50

DOI: 10.23736/S0021-9509.20.11202-3


language: English

The revascularization technique does not impact renal function after proximal abdominal aortic aneurysm open repair

Daniele MASCIA, Alessandro GRANDI , Luca BERTOGLIO, Andrea KAHLBERG, Concetta SARACINO, Germano MELISSANO, Roberto CHIESA

Department of Vascular Surgery, San Raffaele Scientific Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

BACKGROUND: To report the postoperative renal function stratified according to the visceral vessels (VV) revascularization technique used during proximal abdominal aortic aneurisms (p-AAA) open surgical repair (OR).
METHODS: Data from all patients with p-AAA who were submitted to OR between 2010 and 2015 at our Institute were prospectively collected and analyzed. A postoperative deterioration of the estimated glomerular filtration rate (eGFR) by 25% within four days was defined as acute kidney injury (AKI) 1. Only AKI 2 (50% decrease in eGFR) and AKI 3 (75% decrease in eGFR) were considered significant for renal impairment after the procedure. Primary study end point was defined as the presence of AKI 2 or 3. Secondary end points were 30-day mortality and/or any major adverse event.
RESULTS: During the study period, 157 consecutive patients (145 men and 12 women; mean age: 72±7 years) were treated. Sixty (38,2%) were cross-clamped supraceliac, 53 (33,8%) were cross-clamped suprarenal and 44 (28%) were cross-clamped inter/infrarenal. Vessel reattachment was not needed in 104 cases (66.2%). A beveled aortic anastomosis was performed in 10 (6.4%) patients, a beveled anastomosis and left renal artery (LRA) direct revascularization in 10 (6.4%), Crawford inclusion technique in 11 (7%), Crawford inclusion technique and LRA direct revascularization in 6 (3.8%) and direct revascularization of one or more renal arteries in 16 (10.2%). Perioperative mortality was 1.9%. An increased incidence of AKI 2 and AKI 3 was observed in patients undergoing separate LRA revascularization: in particular 40% of beveled proximal anastomosis (P=0.001) and in 16.7% of Crawford inclusion technique (P=0.025), respectively. On the other hand, those patients who did not require any VV revascularization had a decreased incidence of AKI>1 (P=0.010). The follow-up data of 63.6±21 months shows no significant difference in renal function according to the revascularization technique used compared to the perioperative period.
CONCLUSIONS: Postoperative renal failure after p-AAAs repair is still a major concern although perfusion techniques and organ protection are important to reduce its frequency. Despite recent development of complex endovascular techniques, OR, when offered in high-volume centers, remains safe, effective and durable.

KEY WORDS: Aortic aneurysms; Acute kidney injury; Surgical procedures, operative

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