Summary:
BACKGROUND - AIM
It is well known that aortic aneurysm repair in patients with preoperative
renal dysfunction has a higher mortality / morbidity rates than among those
with normal renal function and is an independent risk factor for dissapointing
outcomes. Both endovascular aneurysm repair (EVAR) and open aneurysm repair
(OAR), may lead to a deterioration of renal impairment in different and
specific procedure-related mechanisms. Furthermore, the obligatory serial use
of contrast enhanced CT during follow up poses a major problem when treating
this group of patients. Various studies have examined the effect of both
procedures in patients with a preexisting renal impairment, reporting
conflicting results. The objective of the present study was to provide a
contemporary literature review, in order to define specific directions towards
the management of patients with renal impairment.
METHODS AND MATERIALS
A thorough review of the literature was performed. Systematic search in PubMed
for studies (in English literature) using terms as abdominal aortic aneurysm
(AAA), endovascular aneurysm repair (EVAR), open repair, renal function, renal
impairment, was done. Only references which correlated the methods of aneurysm
rehabilitation with the status of renal function and how it is affected were
included. From over 120 studies initially identified, 58 articles were used in
this review.
CONCLUSION
In patients with moderate renal insufficiency, as it is estimated by Glomerular
Filtration Rate (GFR 30-60mL/min), EVAR is probably safer, while in patients
with severe renal insufficiency (GFR <30 mL/min) the complications and
mortality rated are disappointing for both methods,
rendering justifiable the deferral of the operation until the rupture risk is
too high. However, the existing studies use variable indices for renal
function, making statistical analysis infeasible, and thus the preceding
conclusions are only a suggestion, until further prospective randomized studies
with precise definitions of preoperative and postoperative renal function and
with longterm follow up, arise. The optimal use of pre and intraopertaive
medical agents in combination with alternative imaging methods replacing
conventional CT and angiography may render EVAR the gold standar method for
this high-risk group of patients.
Keywords:
Abdominal aneurysm , Renal function , Renal impairment , Endovascular , Open repair
