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December 23, 2005
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Shane S. Parmer, MD, Douglas Helm, MD, Ronald M. Fairman, MD, Jeffrey P. Carpenter, MD, Omaida C. Velazquez, MD, Jagajan Karmacharya, MD, Edward Y. Woo, MD.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Objective: Endovascular aneurysm repair (EVAR) is rapidly becoming the predominant technique for repair of abdominal aortic aneurysms. Data is conflicting regarding the effect of EVAR on renal function as compared to standard open repair. Furthermore, data for open repair suggests worse outcomes, including renal function, in patients with baseline renal insufficiency (RI). The purpose of this analysis is to compare the effects of open repair versus EVAR on renal function in patients with baseline RI.
Methods: We reviewed our records for patients with preoperative chronic RI (SCr ≥ 1.5 mg/dL) who underwent open or endovascular infrarenal abdominal aortic aneurysm repair between 1999-2004. Ninety eight patients: 46 open (37M, 9F) and 52 EVAR (50M, 2F) patients, underwent aneurysm repair by the same group of vascular surgeons at a single institution. Comparison of preoperative, postoperative and follow-up serum creatinine (SCr) was performed as was the development of postoperative renal impairment (increase in SCr >30%). Statistical analysis was performed using the t-test for continuous variables and proportions with a two-tailed p<0.05 demonstrating significance.
Results: Serum creatinine was not statistically different between the open and EVAR groups during any time period studied, Table. Likewise when comparing the magnitude of change in SCr in patients between the postoperative and follow-up times with preoperative values there were no significant differences between open and EVAR groups. When comparing the change in SCr over time within each group, however, there was a significant increase in SCr in the open group at the postoperative time (2.43 ± 1.20 versus 2.04 ± 0.64, p = 0.012) which returned to baseline during follow-up (1.77 ± 0.72, p = 0.504). Although SCR in the EVAR group increased compared to preoperative value (preop 2.04 ± 0.55, postop 2.27 ± 1.04, follow-up, 2.28 ± 1.22), this failed to reach statistical significance for either the postoperative (p = 0.092) or follow-up (p = 0.081) periods. Postoperative renal impairment was noted in 13 (28%) open and 15 (29%) EVAR patients and was not statistically different between groups. Overall, 1 patient from the open group and 4 patients from the EVAR group required hemodialysis, one in the EVAR group requiring permanent hemodialysis. This was not statistically significant, p = 0.193.
Conclusions: Open and endovascular repair of abdominal aortic aneurysms in patients with baseline CRI can be performed with good preservation of renal function. In contrast to previous reports there were no significant differences between open repair and EVAR with regards to postoperative alterations in renal function. Although patients with CRI develop a significant increase in SCr postoperatively with open repair, this appears to be transient. Preoperative renal dysfunction alone should not exclude either approach.
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A Comparison of Renal Function between Open and Endovascular Aneurysm Repair in Patients with Baseline Chronic Renal Insufficiency
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Shane S. Parmer, MD, Douglas Helm, MD, Ronald M. Fairman, MD, Jeffrey P. Carpenter, MD, Omaida C. Velazquez, MD, Jagajan Karmacharya, MD, Edward Y. Woo, MD.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Objective: Endovascular aneurysm repair (EVAR) is rapidly becoming the predominant technique for repair of abdominal aortic aneurysms. Data is conflicting regarding the effect of EVAR on renal function as compared to standard open repair. Furthermore, data for open repair suggests worse outcomes, including renal function, in patients with baseline renal insufficiency (RI). The purpose of this analysis is to compare the effects of open repair versus EVAR on renal function in patients with baseline RI.
Methods: We reviewed our records for patients with preoperative chronic RI (SCr ≥ 1.5 mg/dL) who underwent open or endovascular infrarenal abdominal aortic aneurysm repair between 1999-2004. Ninety eight patients: 46 open (37M, 9F) and 52 EVAR (50M, 2F) patients, underwent aneurysm repair by the same group of vascular surgeons at a single institution. Comparison of preoperative, postoperative and follow-up serum creatinine (SCr) was performed as was the development of postoperative renal impairment (increase in SCr >30%). Statistical analysis was performed using the t-test for continuous variables and proportions with a two-tailed p<0.05 demonstrating significance.
Results: Serum creatinine was not statistically different between the open and EVAR groups during any time period studied, Table. Likewise when comparing the magnitude of change in SCr in patients between the postoperative and follow-up times with preoperative values there were no significant differences between open and EVAR groups. When comparing the change in SCr over time within each group, however, there was a significant increase in SCr in the open group at the postoperative time (2.43 ± 1.20 versus 2.04 ± 0.64, p = 0.012) which returned to baseline during follow-up (1.77 ± 0.72, p = 0.504). Although SCR in the EVAR group increased compared to preoperative value (preop 2.04 ± 0.55, postop 2.27 ± 1.04, follow-up, 2.28 ± 1.22), this failed to reach statistical significance for either the postoperative (p = 0.092) or follow-up (p = 0.081) periods. Postoperative renal impairment was noted in 13 (28%) open and 15 (29%) EVAR patients and was not statistically different between groups. Overall, 1 patient from the open group and 4 patients from the EVAR group required hemodialysis, one in the EVAR group requiring permanent hemodialysis. This was not statistically significant, p = 0.193.
Conclusions: Open and endovascular repair of abdominal aortic aneurysms in patients with baseline CRI can be performed with good preservation of renal function. In contrast to previous reports there were no significant differences between open repair and EVAR with regards to postoperative alterations in renal function. Although patients with CRI develop a significant increase in SCr postoperatively with open repair, this appears to be transient. Preoperative renal dysfunction alone should not exclude either approach.
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