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

BACKGROUND: To report the postoperative renal function stratified according to the visceral vessels (VV) revascularization technique used during proximal abdominal aortic aneurisms (p-AAA) open surgical repair (OR).

METHODS: Data from all patients with p-AAA who were submitted to OR between 2010 and 2015 at our Institute were prospectively collected and analyzed. A postoperative deterioration of the estimated glomerular filtration rate (eGFR) by 25% within four days was defined as acute kidney injury (AKI) 1. Only AKI 2 (50% decrease in eGFR) and AKI 3 (75% decrease in eGFR) were considered significant for renal impairment after the procedure. Primary study end point was defined as the presence of AKI 2 or 3. Secondary end points were 30-day mortality and/or any major adverse event.

RESULTS: During the study period, 157 consecutive patients (145 men and 12 women; mean age: 72±7 years) were treated. Sixty (38,2%) were cross-clamped supraceliac, 53 (33,8%) were cross-clamped suprarenal and 44 (28%) were cross-clamped inter/infrarenal. Vessel reattachment was not needed in 104 cases (66.2%). A beveled aortic anastomosis was performed in 10 (6.4%) patients, a beveled anastomosis and left renal artery (LRA) direct revascularization in 10 (6.4%), Crawford inclusion technique in 11 (7%), Crawford inclusion technique and LRA direct revascularization in 6 (3.8%) and direct revascularization of one or more renal arteries in 16 (10.2%). Perioperative mortality was 1.9%. An increased incidence of AKI 2 and AKI 3 was observed in patients undergoing separate LRA revascularization: in particular 40% of beveled proximal anastomosis (P=0.001) and in 16.7% of Crawford inclusion technique (P=0.025), respectively. On the other hand, those patients who did not require any VV revascularization had a decreased incidence of AKI>1 (P=0.010). The follow-up data of 63.6±21 months shows no significant difference in renal function according to the revascularization technique used compared to the perioperative period.

CONCLUSIONS: Postoperative renal failure after p-AAAs repair is still a major concern although perfusion techniques and organ protection are important to reduce its frequency. Despite recent development of complex endovascular techniques, OR, when offered in high-volume centers, remains safe, effective and durable.