División de la vena renal izquierda durante la reparación abierta de aneurisma de aorta abdominal

The purpose of this study is to evaluate the impact of left renal vein (LRV) division in patients undergoing open abdominal aortic aneurysm repair (AAA) repair.

This is a systematic review and meta-analysis registered in PROSPERO register of systematic reviews (CRD42025640222) and conducted in accordance to Cochrane's guidelines for systematic review and meta-analysis. PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing outcomes of patients who underwent open AAA repair with and without LRV division. Two authors screened the search results and collected data of interest independently, according to the PRIMA protocol. The primary outcome was 30-day mortality and secondary outcomes were short and long-term renal function. Risk ratio (RR) and mean difference (MD) with corresponding 95% confidence interval (CI) were estimated using a random-effects model. Significance was defined as a p-value <0.05.

A total of 190 studies were screened for inclusion, of which nine studies (8 cohort studies and 1 case-control study) met the inclusion criteria. These studies included a total of 1,324 patients, 350 of whom underwent LRV division, while 974 patients did not. Meta-analysis revealed no significant difference in 30-day mortality (28/205 versus 123/512, RR= 0.90, 95% CI 0.63-1.29; p=0.42, I²=0%), AKI (RR=1.74, 95% CI 0.39-7.83; p=0.33, I²=69%), need for dialysis (4/178 versus 10/473, RR=1.61, 95% CI 0.54-4.84), discharge eGFR (MD=-0.32, 95% CI -2.57-1.92, p=0.60, I²=0%), and discharge serum creatinine (sCr) (MD=-0.01, 95% CI -0.02-0.01, p = 0.29, I² = 0%). LRV division was associated with an increase post operative sCr (MD=0.08, 95% CI 0.04-0.11, p=0.009, I²=0%) compared to patients with the LRV left intact.

Among patients undergoing AAA open surgical repair, our results demonstrate that LRV division is not associated with an increase in 30-day mortality or worse renal function.