Endovascular Repair of Aortic Aneurysms in Patients With Renal Insufficiency

Abstract

It is widely thought that chronic renal insufficiency substantially increases the risk of endovascular aneurysm repair and is a relative contraindication to the procedure and to the use of intra-arterial contrast agents. We reviewed a 5-year experience with endovascular aneurysm repair to determine whether the procedure and use of intra-arterial contrast agents has a major deleterious effect on renal function in patients with and without preexisting chronic renal insufficiency. Endovascular aneurysm repair, with a variety of endografts, was performed on 200 patients. Intra-arterial contrast agents were used. The patients were retrospectively assigned to three groups based on their preoperative serum creatinine levels (mg/dL); Group I (n = 108), less than 1.5 (normal range); Group 11 (n = 65), 1.5 to 2.0, and Group III (n = 27), 2.1 to 3.5 without a history of hemodialysis. In Groups 11 and 111, patients were hydrated perioperatively, received mannitol intraoperatively, and did not receive nephrotoxic drugs, other than an nonionic contrast agent, during the procedure. The incidence of postoperative complications between the three study groups was not significantly different. In patients with chronic renal insufficiency who do not require dialysis, endovascular aneurysm repair with intra-arterial contrast agents can be performed with a limited and acceptable morbidity and mortality, similar to that observed with open aneurysm repair. Unlike other reports in which perioperative precautions were not used, our study shows that with endovascular aneurysm repair, the risks of worsening renal failure, dialysis, and death were only slightly, and not significantly, greater in patients with preoperative chronic renal insufficiency than in those with normal renal function. With appropriate precautions, elevated creatinine levels need not be a contraindication to the use of intra-arterial contrast agents in endovascular aneurysm repair.