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A perioperative strategy for abdominal aortic aneurysm in patients with chronic renal insufficiency

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Abstract

Purpose

The outcomes of open surgical repair (OR) or endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) are favorable; however, pre-existing chronic renal insufficiency (CRI) is considered to be a risk factor that can affect the long-term outcome. We evaluated our surgical strategy for AAA in patients with CRI by analyzing their pre- and postoperative renal function.

Methods

We conducted a retrospective chart review of CRI patients who underwent OR (n = 28) or EVAR (n = 31) for infra-renal AAA in our institution between 2009 and 2013. Our operative strategy included pre- and postoperative adequate hydration, postoperative diuretics and low-dose dopamine for both groups, intravascular ultrasonography and carbon dioxide angiography to reduce the amount of contrast media needed in the EVAR group, and occasional intraoperative mannitol for the OR group.

Results

The preoperative estimated glomerular filtration rate (eGFR) increased significantly in the postoperative period and remained similar 6 months later in both groups, without any difference in changes between the groups. In-hospital postoperative complications included leg occlusion in one EVAR patient. There were no complication-related deaths in either group.

Conclusions

Postoperative renal function was similar after the two approaches, indicating that both procedures could be performed safely using our strategy for patients with CRI.

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Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Makoto Haga, Katsuyuki Hoshina, Kunihiro Shigematsu & Toshiaki Watanabe

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  1. Makoto Haga
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  2. Katsuyuki Hoshina
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  3. Kunihiro Shigematsu
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  4. Toshiaki Watanabe
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Correspondence to Katsuyuki Hoshina.

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Haga, M., Hoshina, K., Shigematsu, K. et al. A perioperative strategy for abdominal aortic aneurysm in patients with chronic renal insufficiency. Surg Today 46, 1062–1067 (2016). https://doi.org/10.1007/s00595-015-1286-0

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  • DOI: https://doi.org/10.1007/s00595-015-1286-0

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