• 作者：F. Á ; lvarez Marcos ; ^{franalmar@gmail.com} ; A. Zanabili Al-Sibbai ; J.M. Gutié ; rrez Juliá ; n ; J.M. Llaneza Coto ; A. Garcí ; a de la Torre ; A. Valle Gonzá ; lez
• 关键词：Aneurisma ; Insuficiencia renal ; Pronó ; stico ; Reparació ; n por té ; cnicas endovasculares
• 刊名：Angiolog铆a
• 出版年：2010
• 期刊代码：pca50_00033170
• 类别：med
• 出版时间：November-December 2010
• 卷：62
• 期：6
• 页码：207-213
• 文件大小：174 K

Introduction

Postoperative renal impairment can predict outcomes and survival of open and endovascular abdominal aortic aneurysm repair.

Objectives

To assess renal function in abdominal aortic surgery, and analysing its predictive power for both short and long-term adverse events.

Patients

A total of 310 patients with abdominal aorta aneurysm who underwent surgery in our centre (open aortic repair [OAR] n = 150, endovascular aortic repair [EVAR] n = 160) from 2003 to 2007, with a mean postoperative follow-up of 37.9 months.

Methods

Prospective collection of clinical data, serum creatinine determinations every 12 hours up to 3rd postoperative day. Uni- and multivariate analysis, ROC curves and Kaplan-Meier survival plots.

Results

Mean age and ASA risk score were significantly higher in the endovascular group (p < 0.001). Perioperative mortality was 4.2%(4%open repair, 4.4 endovascular, p = 0.869), and preoperative creatinine levels were similar in both groups (OAR 1.10 卤 0.21 mg/dl, EVAR 1.08 卤 0.25 mg/dl, p = 0.570). Preoperative renal impairment (p < 0.001) was found to be associated with higher short-term mortality, complications and reintervention, but without showing independence to other risk factors. Postoperative renal dysfunction was more common in open repair group (39.8%vs 21.8%, odds ratio [OR] = 1.82, p = 0.015) and successfully predicted (p < 0.001) adverse events both in open and endovascular repair, and lower 3-year survival rate (log rank p = 0.038). The multivariate analysis confirmed this predictive power for both techniques (open repair OR = 4.7, endovascular OR = 4.4). Risk was higher for serum creatinine values over 1.4 mg/dl on any of the 3 postoperative days (ROC AUC 0.919).

Conclusions

Postoperative renal impairment more precisely identifies groups of patients at increased risk for short and long-term adverse events, and independently of other risk factors or preoperative renal dysfunction.