1
|
Radak D, Neskovic M, Otasevic P, Isenovic ER. Renal Dysfunction Following Elective Endovascular Aortic Aneurysm Repair. Curr Vasc Pharmacol 2020; 17:133-140. [PMID: 29149818 DOI: 10.2174/1570161115666171116163203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 02/01/2023]
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative disease of the aortic wall with potentially fatal complications. Open repair (OR) was considered the gold standard, until the emergence of endovascular aneurysm repair (EVAR), which is less invasive and equally (if not more) effective. As the popularity of endovascular procedures grows, related complications become more evident, with kidney damage being one of them. Although acute kidney injury (AKI) following EVAR is relatively common, its true incidence is still uncertain. Also, there is insufficient data concerning long-term renal outcomes after EVAR, especially with repeated contrast agent exposure. Despite the lack of firm evidence on the effectiveness of individual strategies, it is evident that prevention of AKI following EVAR requires a multifactorial approach. This review focuses on recent findings based on human studies regarding the current evidence of renal impairment after EVAR, its quantification and strategies for its prevention.
Collapse
Affiliation(s)
- Djodje Radak
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade 11040, Serbia
| | - Mihailo Neskovic
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade 11040, Serbia
| | - Petar Otasevic
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade 11040, Serbia
| | - Esma R Isenovic
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Sciences Vinca, University of Belgrade, Mike Petrovica Alasa 12-14, Belgrade 11000, Serbia
| |
Collapse
|
2
|
Hu DK, Pisimisis GT, Sheth RA. Repair of abdominal aortic aneurysms: preoperative imaging and evaluation. Cardiovasc Diagn Ther 2018; 8:S157-S167. [PMID: 29850427 DOI: 10.21037/cdt.2018.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Imaging is a critical component of the pre-procedure evaluation and planning of endovascular aneurysm repair (EVAR). Imaging is the mainstay for proper assessment of procedural candidacy, relevant vascular anatomy, device selection, and surgical approach. Computed tomography angiography (CTA) has long been considered the preferred modality for pre-operative imaging and evaluation prior to EVAR. Recently, advances in image quality and software technology have further enhanced the proceduralist's ability to plan and perform EVAR. In this review, we highlight the current state of the art to provide interventionalists a contemporary assessment of the available tools for pre-operative imaging and evaluation prior to EVAR.
Collapse
Affiliation(s)
- David K Hu
- Baylor College of Medicine, Houston, TX, USA.,Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - George T Pisimisis
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
Coscas R, Wagner S, Vilaine E, Sartorius A, Javerliat I, Alvarez JC, Goeau-Brissonniere O, Coggia M, Massy Z. Preoperative Evaluation of the Renal Function before the Treatment of Abdominal Aortic Aneurysms. Ann Vasc Surg 2016; 40:162-169. [PMID: 27890838 DOI: 10.1016/j.avsg.2016.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic impaired renal function constitutes a major risk factor of morbi-mortality during the treatment of an abdominal aortic aneurism (AAA). The inflammatory state due to the AAA could result in a reduction in the muscular mass and an overestimation of the glomerular filtration rate (GFR) with the usual formulas. The objective of this study was to determine if the formulas used to evaluate the estimated GFR were adapted in patients with AAA. MATERIALS AND METHODS Between August 2013 and November 2014, we conducted an exploratory study to evaluate the renal function before surgery for AAA in 28 patients. The renal function was evaluated by (1) the dosage of plasmatic creatinine, (2) the GFR estimated with the Cockroft-Gault, Modification of Diet in Renal Disease (MDRD), and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas, (3) the creatinine clearance (CC), and (4) the direct measurement of the GFR with a reference method (iohexol clearance). Statistical analysis was carried out to compare and correlate the GFR estimated by the various formulas with the GFR measured by the reference technique. RESULTS The study included 21 men (75%) and 7 women (25%), with a median age of 76 years (58-89). The measured GFR was correlated with the GFR estimated from the CKD-EPI (rho = 0.78, P < 0.0001), the MDRD (rho = 0.78, P < 0.0001), the Cockroft-Gault (rho = 0.65, P = 0.0002), and CC (rho = 0.86, P < 0.0001). However, there were important individual variations between estimated and measured GFR. As regards the detection of the patients presenting a GFR <60 mL/min/1.73 m2, the sensitivities of the CKD-EPI, MDRD, Cockroft-Gault formulas and CC were 64%, 64%, 71%, and 70%, respectively. Specificities were 71%, 79%, 57%, and 100%, respectively. The estimation of the GFR by the CKD-EPI formula had the lowest bias (-3.0). Bland-Altman plots indicated that the estimation of the GFR by the CKD-EPI formula had the best performance in comparison with the other methods. CONCLUSIONS This study found a statistical correlation between the measurement of the GFR and the various formulas available to estimation the GFR among AAA patients. The CKD-EPI formula is most appropriate. However, there were important individual variations between the measurement and the estimations of the GFR. A larger scale study is necessary to determine the profile of the patients with a risk of error in the estimation of the GFR. The French recommendations on the evaluation of the renal function before AAA treatment remain based on serum creatinine and should be revalued.
Collapse
Affiliation(s)
- Raphael Coscas
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France.
| | - Sandra Wagner
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) Network, Vandoeuvre-lès-Nancy, France
| | - Eve Vilaine
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Service de Néphrologie-Dialyse, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Albane Sartorius
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Isabelle Javerliat
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Jean Claude Alvarez
- Department of Pharmacology and Toxicology, Raymond Poincare Hospital, AP-HP, and INSERM U-1173, Université de Versailles Saint-Quentin en Yvelines, Garches, France
| | - Olivier Goeau-Brissonniere
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Marc Coggia
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Ziad Massy
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) Network, Vandoeuvre-lès-Nancy, France; Service de Néphrologie-Dialyse, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| |
Collapse
|