Abdominal aortic aneurysm (AAA) is a degenerative disease of the aortic wall with potentially fatal complications. The widespread adoption of endovascular aneurysm repair (EVAR), which is less invasive and equally (if not more) effective for abdominal aortic aneurysms (AAA), is due to the obvious advantages of the procedure compared to the traditional open repair. As the popularity of endovascular procedures grows, related complications become more evident, with kidney damage being one of them. Although acute kidney injury following EVAR is relatively common, its true incidence is still uncertain. The purpose of this study was to assess the incidence of acute kidney injury among patients treated with endovascular repair of ruptured AAA. In addition, we aimed to determine the predictors of PC-AKI in patients with abdominal aortic aneurysm treated with EVAR.
Patients and methods: We retrospectively analyzed a prospective registry of abdominal aortic aneurysm of 247 patients operated endovascularly at a single center between 2015 and 2021. Due to a lack of clinical data, data of 192 patients were reviewed for postcontrast acute kidney injury. Additional comorbidities were included in this study: hypertension, diabetes mellitus, atrial fibrillation, chronic coronary syndrome, COPD, and chronic kidney disease. Follow-up examinations were performed before the procedure and 48 h after contrast administration.
Results: The group of 36 patients developed PC-AKI, which is 19% of the entire study population. Hypertension, diabetes, chronic kidney disease, male gender, and incidence of PC-AKI were more prevalent in patients with higher aortic aneurysm diameter ≥67 mm. In multiple regression analyses, independent predictors of PC-AKI were serum creatinine, chronic kidney disease, male gender, and aortic aneurysm diameter ≥67 mm.
Conclusions: One of the major complications after EVAR is acute kidney injury, which is linked to higher death and morbidity rates. Independent risk factors for postcontrast acute kidney injury were chronic kidney disease, male gender, and aortic diameter. Only aortic diameter could be modifiable risk factor, and earlier surgery could be considered to yield better outcomes. More research is critically needed to determine how AKI affects long-term outcomes and to look at preventive options.
Keywords: EVAR; abdominal aortic aneurysm; acute kidney injury.