The revascularization technique does not impact renal function after proximal abdominal aortic aneurysm open repair

Area of Science:

• Vascular Surgery
• Nephrology
• Surgical Outcomes

Background:

• Proximal abdominal aortic aneurysms (p-AAA) repair carries a risk of postoperative renal dysfunction.
• The impact of visceral vessel (VV) revascularization techniques on renal function after open repair (OR) requires detailed analysis.

Purpose of the Study:

• To evaluate postoperative renal function following p-AAA open surgical repair (OR).
• To stratify renal function based on the specific visceral vessel (VV) revascularization technique employed.

Main Methods:

• Prospective data collection from 157 patients undergoing p-AAA OR between 2010-2015.
• Acute kidney injury (AKI) defined as a ≥25% decrease in eGFR; focus on significant AKI (≥50% decrease).
• Analysis of various revascularization techniques including beveled anastomosis, Crawford inclusion, and direct renal artery revascularization.

Main Results:

• Increased incidence of significant AKI (≥50% eGFR decrease) observed with separate left renal artery revascularization (40% for beveled anastomosis, 16.7% for Crawford technique).
• Patients not requiring VV revascularization showed a decreased incidence of AKI.
• Perioperative mortality was 1.9%.

Conclusions:

• Postoperative renal failure remains a concern in p-AAA repair, emphasizing the importance of organ protection strategies.
• Despite perioperative risks associated with specific revascularization techniques, long-term renal function did not significantly differ across techniques.
• Open repair in high-volume centers remains a safe, effective, and durable option for p-AAA.