Acute Kidney Injury Following Pararenal Abdominal Aortic Repair Requiring Suprarenal Abdominal Aortic Cross-Clamping

Shinichi Imai, Shinichi Hiromatsu, Ryo Kanamoto, Yuusuke Shintani, Shinichi Nata, Kazuyoshi Takagi, Hiroyuki Otsuka, Satoru Tobinaga, Seiji Onitsuka, Hiroyuki Tanaka

Department of Surgery, Kurume University School of Medicine, Kurume, Japan

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–B

Abstract

Introduction:

Despite advances in endovascular abdominal aortic aneurysm repair (EVAR), cases of pararenal abdominal aortic aneurysm (PRAAA) excluded from the instructions for use of EVAR have increased in our institution. In this study, we assessed acute kidney injury (AKI) after open repair for PRAAA requiring suprarenal abdominal aortic cross-clamping (SRACC) in our institution.

Objective

To evaluate AKI after open repair for PRAAA requiring SRACC in our institution.

Methods:

Of 656 elective patients undergoing abdominal aortic aneurysm (AAA) repair, we retrospectively reviewed 30 patients (4.6%) with PRAAA requiring SRACC, excluding 4 patients who received hemodialysis and renal preservation at Kurume University Hospital from January 2001 to June 2016. Postoperative AKI occurred in 6 (20%) of 30 patients who underwent AAA repair requiring SRACC. We compared the 6 patients with AKI to 24 patients without AKI.

Results:

There were no significant differences in patient characteristics between the two groups, except for cerebrovascular disease. Patients with postoperative AKI had significantly longer mean renal ischemia times than those without AKI (42.7±14.2 vs. 29.9±10.1, p=0.018). Total length of hospital stay was longer in patients with postoperative AKI than in patients without AKI (25.7±12.3 vs. 17.7±7.4, p=0.047), but there were no cases of in-hospital death, and no patients required postoperative renal replacement therapy (RRT). In the long term, patients with postoperative AKI had a higher rate of progression of CKD thanpatients without AKI (p=0.002), but the 5-year survival rates were 100%in both groups.

Conclusion:

Patients with postoperative AKI had a higher rate of progression of CKD, but there was no significant difference in survival rate or requirements for postoperative RRT. Clinical outcome of open repair for PRAAA requiring simple SRACC without renal preservation was generally satisfactory.