Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair

George T. Pisimisis, Ali Khoynezhad, Khalid Bashir, Matthew J. Kruse, Carlos E. Donayre, Rodney A. White

Research output: Contribution to journalArticle

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Abstract

Objectives: The risk of renal failure after thoracic endovascular aortic repair is not widely established. The aim of this study was to assess the incidence and risk factors of renal failure. Methods: Between 1998 and 2008, 175 consecutive patients underwent 210 procedures at 2 tertiary academic institutions. Similar nephroprotective protocols and intravascular ultrasound were used. Retrospective analysis was performed. Generalized linear model was used to identify factors associated with change in postoperative estimated glomerular filtration rate. Results: Underlying aortic diseases included 103 aneurysms, 72 dissections, 21 transections, and 14 penetrating ulcers. Median preoperative estimated glomerular filtration rate was 65 mL · min -1 · 1.73 m-2. Contrast media averaged 108.7 ± 69.8 mL. Median estimated glomerular filtration rates within 48 hours and 30 days were 69 and 67 mL · min-1 · 1.73 m -2, respectively. Rates of acute renal dysfunction risk (>25% estimated glomerular filtration rate decrease), acute kidney injury (>50% estimated glomerular filtration rate decrease), acute kidney function failure (>75% estimated glomerular filtration rate decrease), and hemodialysis were 9.8% (19/193), 1.6% (3/193), 0% (0/193), and 0.5% (1/193), respectively. Rates of renal dysfunction at 1 month and 6 months were 13.3% (10/75) and 17.7% (6/34), respectively. Risk factors for acute renal dysfunction were intraoperative hypotension, stroke, sepsis, lengthy procedures, and number of stents; at 1 and 6 months they were increased age, male gender, African American race, diabetes mellitus, chronic pulmonary disease, smoking, and zone 0 to 1 graft deployment. Obesity was nephroprotective. Conclusions: Thoracic aortic endograft has a significant rate of renal dysfunction; however, it is lower in this cohort than in previous smaller series. Routine use of intravascular ultrasound and reduced contrast may have contributed to lower rates of renal insufficiency.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number6 SUPPL.
DOIs
StatePublished - Dec 2010

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Glomerular Filtration Rate
Thorax
Kidney
Incidence
Renal Insufficiency
Acute Kidney Injury
Aortic Diseases
African Americans
Hypotension
Contrast Media
Lung Diseases
Ulcer
Stents
Aneurysm
Renal Dialysis
Dissection
Linear Models
Sepsis
Diabetes Mellitus
Chronic Disease

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair. / Pisimisis, George T.; Khoynezhad, Ali; Bashir, Khalid; Kruse, Matthew J.; Donayre, Carlos E.; White, Rodney A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No. 6 SUPPL., 12.2010.

Research output: Contribution to journalArticle

Pisimisis, George T. ; Khoynezhad, Ali ; Bashir, Khalid ; Kruse, Matthew J. ; Donayre, Carlos E. ; White, Rodney A. / Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 140, No. 6 SUPPL.
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abstract = "Objectives: The risk of renal failure after thoracic endovascular aortic repair is not widely established. The aim of this study was to assess the incidence and risk factors of renal failure. Methods: Between 1998 and 2008, 175 consecutive patients underwent 210 procedures at 2 tertiary academic institutions. Similar nephroprotective protocols and intravascular ultrasound were used. Retrospective analysis was performed. Generalized linear model was used to identify factors associated with change in postoperative estimated glomerular filtration rate. Results: Underlying aortic diseases included 103 aneurysms, 72 dissections, 21 transections, and 14 penetrating ulcers. Median preoperative estimated glomerular filtration rate was 65 mL · min -1 · 1.73 m-2. Contrast media averaged 108.7 ± 69.8 mL. Median estimated glomerular filtration rates within 48 hours and 30 days were 69 and 67 mL · min-1 · 1.73 m -2, respectively. Rates of acute renal dysfunction risk (>25{\%} estimated glomerular filtration rate decrease), acute kidney injury (>50{\%} estimated glomerular filtration rate decrease), acute kidney function failure (>75{\%} estimated glomerular filtration rate decrease), and hemodialysis were 9.8{\%} (19/193), 1.6{\%} (3/193), 0{\%} (0/193), and 0.5{\%} (1/193), respectively. Rates of renal dysfunction at 1 month and 6 months were 13.3{\%} (10/75) and 17.7{\%} (6/34), respectively. Risk factors for acute renal dysfunction were intraoperative hypotension, stroke, sepsis, lengthy procedures, and number of stents; at 1 and 6 months they were increased age, male gender, African American race, diabetes mellitus, chronic pulmonary disease, smoking, and zone 0 to 1 graft deployment. Obesity was nephroprotective. Conclusions: Thoracic aortic endograft has a significant rate of renal dysfunction; however, it is lower in this cohort than in previous smaller series. Routine use of intravascular ultrasound and reduced contrast may have contributed to lower rates of renal insufficiency.",
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T1 - Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair

AU - Pisimisis, George T.

AU - Khoynezhad, Ali

AU - Bashir, Khalid

AU - Kruse, Matthew J.

AU - Donayre, Carlos E.

AU - White, Rodney A.

PY - 2010/12

Y1 - 2010/12

N2 - Objectives: The risk of renal failure after thoracic endovascular aortic repair is not widely established. The aim of this study was to assess the incidence and risk factors of renal failure. Methods: Between 1998 and 2008, 175 consecutive patients underwent 210 procedures at 2 tertiary academic institutions. Similar nephroprotective protocols and intravascular ultrasound were used. Retrospective analysis was performed. Generalized linear model was used to identify factors associated with change in postoperative estimated glomerular filtration rate. Results: Underlying aortic diseases included 103 aneurysms, 72 dissections, 21 transections, and 14 penetrating ulcers. Median preoperative estimated glomerular filtration rate was 65 mL · min -1 · 1.73 m-2. Contrast media averaged 108.7 ± 69.8 mL. Median estimated glomerular filtration rates within 48 hours and 30 days were 69 and 67 mL · min-1 · 1.73 m -2, respectively. Rates of acute renal dysfunction risk (>25% estimated glomerular filtration rate decrease), acute kidney injury (>50% estimated glomerular filtration rate decrease), acute kidney function failure (>75% estimated glomerular filtration rate decrease), and hemodialysis were 9.8% (19/193), 1.6% (3/193), 0% (0/193), and 0.5% (1/193), respectively. Rates of renal dysfunction at 1 month and 6 months were 13.3% (10/75) and 17.7% (6/34), respectively. Risk factors for acute renal dysfunction were intraoperative hypotension, stroke, sepsis, lengthy procedures, and number of stents; at 1 and 6 months they were increased age, male gender, African American race, diabetes mellitus, chronic pulmonary disease, smoking, and zone 0 to 1 graft deployment. Obesity was nephroprotective. Conclusions: Thoracic aortic endograft has a significant rate of renal dysfunction; however, it is lower in this cohort than in previous smaller series. Routine use of intravascular ultrasound and reduced contrast may have contributed to lower rates of renal insufficiency.

AB - Objectives: The risk of renal failure after thoracic endovascular aortic repair is not widely established. The aim of this study was to assess the incidence and risk factors of renal failure. Methods: Between 1998 and 2008, 175 consecutive patients underwent 210 procedures at 2 tertiary academic institutions. Similar nephroprotective protocols and intravascular ultrasound were used. Retrospective analysis was performed. Generalized linear model was used to identify factors associated with change in postoperative estimated glomerular filtration rate. Results: Underlying aortic diseases included 103 aneurysms, 72 dissections, 21 transections, and 14 penetrating ulcers. Median preoperative estimated glomerular filtration rate was 65 mL · min -1 · 1.73 m-2. Contrast media averaged 108.7 ± 69.8 mL. Median estimated glomerular filtration rates within 48 hours and 30 days were 69 and 67 mL · min-1 · 1.73 m -2, respectively. Rates of acute renal dysfunction risk (>25% estimated glomerular filtration rate decrease), acute kidney injury (>50% estimated glomerular filtration rate decrease), acute kidney function failure (>75% estimated glomerular filtration rate decrease), and hemodialysis were 9.8% (19/193), 1.6% (3/193), 0% (0/193), and 0.5% (1/193), respectively. Rates of renal dysfunction at 1 month and 6 months were 13.3% (10/75) and 17.7% (6/34), respectively. Risk factors for acute renal dysfunction were intraoperative hypotension, stroke, sepsis, lengthy procedures, and number of stents; at 1 and 6 months they were increased age, male gender, African American race, diabetes mellitus, chronic pulmonary disease, smoking, and zone 0 to 1 graft deployment. Obesity was nephroprotective. Conclusions: Thoracic aortic endograft has a significant rate of renal dysfunction; however, it is lower in this cohort than in previous smaller series. Routine use of intravascular ultrasound and reduced contrast may have contributed to lower rates of renal insufficiency.

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