Журнал клинических случаев

Accessory Renal Blood Vessels as the Potential Risk Factor of Renal Failure for Endovascular Treatment in Abdominal Aortic Aneurysm

Abstract

Zietek-Czeszak A , Gutowski P and Zietek Z

Purpose: Despite the advantages of endovascular procedures (EVAR) some authors are doubts to recommend this method for some patients. It main concerns the patients with accessory renal arteries (ARAs) and an increased risk of kidney failure. The aim of this work was to evaluate the impact of accessory renal arteries on the renal complications after EVAR.
Methods: 54 of non-randomized patients with ARAs were enrolled to project. The endovascular aneurysm repair (EVAR) was performed in 30 patients and in other 24 classical surgery. 70 patients without ARAs composed the control. Kidney condition was estimated on RIFLE-AKIN classification evaluating concentration of creatinine, urea, glomerular filtration rate (GFR), and urine output per hour (UO). The multivariate regression analysis (ANCOVA test) was applied to correct for confounding and increase of precision of an estimated differences.
Results: The parameters after EVAR procedure did not differ significantly in comparison with preoperative value of urea (p=0.6), creatinine (p=0.16), GFR (p=0.4) and urine output (p=0.8). The ANOVA test revealed also that postoperative parameters in all group of patients did not differ significantly. Although, data in classical approach both with or without ARAs shown a slightly tendency towards renal failure by higher concentration of urea (46.1 vs. 45.1) and creatinine (1.26 vs. 1.21) and lower GFR (61 vs. 66) and urine output per hour (0.60 vs. 0.61). In multivariate regression analysis was shown the preoperative renal failure as an independent factor of acute renal injury. According to RIFLE-AKIN algorithm none parameters did not reach the expected postoperative value which allow to diagnose one of the stadia of acute kidney injury.
Conclusions: Based on the results in patients with ARAs but normal function of kidney the EVAR procedure can be considered as the safe method.