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Is elevated creatinine level a contraindication to endovascular aneurysm repair?
Manish Mehta1, Frank J Veith, Evan C Lipsitz
1Division of Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA. MehtaM@mail.amc.edu
Journal of Vascular Surgery
|January 14, 2004
Summary
Endovascular abdominal aortic aneurysm repair (EVAR) is safe for patients with chronic renal insufficiency (CRI) not requiring dialysis. With precautions, risks are similar to those without CRI, with hypotension and contrast volume being key risk factors.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Chronic renal insufficiency (CRI) is often considered a contraindication for endovascular abdominal aortic aneurysm repair (EVAR) due to perceived risks.
- Intra-arterial contrast agents (IACA) used in EVAR may exacerbate renal dysfunction in patients with CRI.
Purpose of the Study:
- To evaluate the safety and impact of EVAR and IACA on renal function in patients with and without pre-existing CRI.
- To determine if CRI significantly increases morbidity and mortality associated with EVAR.
Main Methods:
- Retrospective review of 200 patients undergoing EVAR with IACA.
- Patients stratified into three groups based on preoperative serum creatinine levels (Cr < 1.5, 1.5–2.0, and 2.1–3.5 mg/dL).
- Perioperative hydration and mannitol administered to groups with higher Cr; nonionic contrast agent used.
Main Results:
- No statistically significant difference in postoperative complications among the three groups.
- Transient increases in serum Cr, temporary hemodialysis, and renal failure deaths occurred at low rates across all groups.
- Perioperative hypotension and larger contrast volumes were significant risk factors for elevated Cr and death.
Conclusions:
- EVAR with IACA is feasible and carries acceptable morbidity/mortality in patients with CRI not requiring dialysis.
- With appropriate precautions, CRI is not a significant contraindication to EVAR.
- Minimizing contrast volume and avoiding perioperative hypotension are crucial for preserving renal function during EVAR.