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1.
《Journal of vascular surgery》2019,69(5):1421-1428
BackgroundRenal dysfunction is a well-described complication of open juxtarenal abdominal aortic aneurysm repair, but the associated risk factors and corresponding impact on survival are not well described.MethodsWe identified all patients not on hemodialysis undergoing open repair of nonruptured juxtarenal aneurysms in the Vascular Quality Initiative from 2003 to 2017. We used mixed-effects logistic regression to determine factors associated with in-hospital postoperative renal dysfunction, including acute kidney injury (AKI, defined as serum creatinine concentration increase >0.5 mg/dL) and new renal replacement therapy (RRT), as well as the association between postoperative renal function and perioperative mortality. Cox regression was used to determine the association between postoperative renal complications and long-term survival.ResultsWe identified 2635 open juxtarenal repairs, of which 621 (24%) were complicated by AKI. The majority of these (20% of the overall cohort) were AKI alone, but 2.2% required temporary RRT and an additional 1.7% were permanently dialysis dependent. Factors independently associated with postoperative renal dysfunction included renal-visceral ischemia time (per minute: odds ratio [OR], 1.01 [1.01-1.02]; P < .001), clamp site (above both renal arteries: OR, 1.4 [1.1-1.8; P = .02]; supraceliac: OR, 1.7 [1.1-2.5; P = .01]), statin use (OR, 1.5 [1.1-2.0]; P = .01), male sex (OR, 1.7 [1.2-2.2]; P = .002), and preoperative renal function (glomerular filtration rate [GFR] of 45-60 mL/min/1.73 m2: OR, 1.8 [1.3-2.5; P < .001]; GFR of 30-45 mL/min/1.73 m2: OR, 1.9 [1.2-2.8; P = .003]; GFR of <30 mL/min/1.73 m2: OR, 6.2 [3.1-12.2; P < .001]). When renal-visceral ischemia time was categorized, there was no difference in risk of postoperative renal dysfunction until >25 minutes, but risk increased stepwise thereafter (25-39 minutes: OR, 1.6 [1.2-2.1; P = .004]; 40+ minutes: OR, 2.6 [1.9-3.5; P < .001]). Neither mannitol nor the use of cold renal perfusion was associated with renal complications or mortality in the overall cohort, but cold renal perfusion was associated with lower risk of AKI when clamp times exceeded 25 minutes (OR, 0.4 [0.2-0.97]; P = .041). Postoperative renal dysfunction was associated with higher adjusted perioperative mortality (AKI: OR, 2.6 [1.4-5.0; P < .01]; RRT: OR, 10.5 [4.0-27.6; P < .001]) and significantly higher risk of long-term mortality (AKI: hazard ratio, 1.5 [1.0-2.1; P = .049]; RRT: hazard ratio, 5.8 [3.2-10.3; P < .001]).ConclusionsPostoperative renal dysfunction, even a mild elevation in creatinine concentration, is associated with higher perioperative and long-term mortality. Although the routine use of mannitol and cold renal perfusion was not associated with postoperative renal dysfunction after open juxtarenal repair, cold renal perfusion was associated with lower risk of AKI if clamp times exceeded 25 minutes. 相似文献
2.
Yi‐Po Tsang Renny Ling‐Chu Yien Kendrick Yip‐Kan Tang Sherwin Shing‐Wai Lo Michael Ka‐Wah Li 《Surgical Practice》2014,18(2):102-104
Chimney grafts (CG) have been used in the repair of juxtarenal aortic aneurysm (JAA) as a pure endovascular approach, which involve the concurrent deployment of an aortic endograft with covered stents in the renal arteries. In the present study, we report a rare but significant complication of chimney grafting in a case of JAA with iliac artery ectasia. During the placement of CG, one of the covered stents was dislodged in a distal branch of the right renal artery, resulting in segmental infarct of the right kidney. 相似文献