Document Detail


Comparison of modern open infrarenal and pararenal abdominal aortic aneurysm repair on early outcomes and renal dysfunction at one year.
MedLine Citation:
PMID:  21620619     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was conducted to review contemporary results of elective open infrarenal abdominal aortic aneurysm (IAAA) and pararenal abdominal aortic aneurysm (PAAA) repairs and determine predictors of death and acute and 1-year renal dysfunction (RD).
METHODS: A retrospective review identified 432 consecutive patients undergoing open IAAA (233 patients) or PAAA (184 patients) repair between January 2000 and December 2007. Demographic, preoperative, intraoperative, and postoperative variables were collected. RD was defined as an increase in creatinine of ≥ 0.5 mg/dL from baseline. Multiple logistic regression models were used to identify predictors of mortality and RD.
RESULTS: Mortality rates were similar between the groups (3.9% IAAA and 6.0% PAAA). Preoperative coronary artery disease (CAD), postoperative myocardial infarction, or pulmonary complications were all strong predictors of operative mortality in patients undergoing repair of PAAAs and IAAAs. However, neither PAAA nor baseline renal insufficiency was an independent predictor of death. Postoperative RD occurred in 32% of patients after PAAA repairs compared with 13% of patients after IAAA repairs (P < .001). The presence of PAAA, baseline hypertension, and hyperlipidemia all correlated positively with postoperative RD, while a trend was noted with baseline renal insufficiency (P = .09). At the 1-year follow-up, 5.1% of patients in the PAAA group had RD compared with none in the IAAA group. Similarly, the serum creatinine level was significantly higher in the PAAA group (1.4 mg/dL vs 1.2 mg/dL, PAAA and IAAA, respectively; P = .02) at 1 year. However, there were no instances of new-onset hemodialysis dependence at 1 year. Mean follow-up was 2.2 years overall.
CONCLUSION: Open PAAA repair can be performed without a significant increase in mortality compared to open IAAA repair. Although the incidence of renal function deterioration after open PAAA repairs remains higher than with open IAAA repairs, the overall incidence remains low at 1-year follow-up.
Authors:
Geetha Jeyabalan; Taeyoung Park; Robert Y Rhee; Michel S Makaroun; Jae-Sung Cho
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-05-28
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2011-11-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  654-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Aneurysm, Abdominal / mortality,  surgery*
Biological Markers / blood
Blood Vessel Prosthesis Implantation / adverse effects,  methods*,  mortality
Chi-Square Distribution
Creatinine / blood
Female
Humans
Kidney / physiopathology*
Kidney Diseases / blood,  etiology*,  mortality,  physiopathology
Logistic Models
Male
Odds Ratio
Pennsylvania
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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