Abstract

Coverage of one or both renal arteries may be required to facilitate endovascular repair (EVAR) in patients who are not candidates for open surgery in ruptured abdominal aortic aneurysms (rAAA). We sought to understand the consequences of renal coverage during these emergent procedures.Utilizing the VQI dataset from 2013-2018, we selected patients who had undergone EVAR for rAAA. Patients were distinguished by whether they had none, unilateral, or bilateral renal artery coverage. Patients were excluded if they were previously on dialysis or had an intervention to preserve renal perfusion. Primary endpoints included in-hospital mortality, composite permanent-dialysis/30-day-death, and 1-year survival.Overall there were 2278 patients presenting with ruptured aneurysms. The majority of patients had no renal artery coverage (n = 2,230; 98%), followed by single renal artery coverage (n = 30; 1.2%), and finally bilateral renal artery coverage (n = 18, 0.8%). On multivariate regression, bilateral renal coverage was associated with increased odds of in-hospital mortality (OR=5.7, +/-4; p=.030) permanent-dialysis/30-day-death (OR=9.5, +/-7; p=.016), and permanent dialysis (OR=47.5, +/-47; p<.001). Two patients with bilateral renal coverage did not suffer permanent-dialysis/death. Single renal artery coverage significantly increased the odds of permanent-dialysis/30-day-death (OR=2.8, +/-1.6; p=.044) driven mainly by its effect on the outcome of permanent-dialysis (OR=12.3, +/-6; p <.001). Unadjusted Kaplan Meier one-year survival estimates were significantly lower with bilateral renal coverage (HR=3.4, p=.0002). Bilateral coverage remained a significant predictor on adjusted analysis (HR=3.5, p=0.002), however single renal coverage did not significantly affect survival in unadjusted or adjusted models.Bilateral renal coverage in rAAA significantly increases in-hospital mortality and lowers long-term survival. While single renal artery coverage increases the risk of permanent dialysis/30-day death driven mainly by its affect on permanent dialysis, it does not significantly affect in-hospital mortality or one-year survival and may be a viable option for select patients with rAAA.

View details for DOI 10.1016/j.avsg.2019.05.005

View details for PubMedID 31201979