The Surgical Treatment of Abdominal Aortic Aneurysms in Patients with Light to Moderate Renal Dysfunction

Objective : The incremental surgical risk caused by mild or moderate renal dysfunction in patients undergoing surgery for an abdominal aortic aneurysm is not well defined. The aim of this study is to analyze the prognostic significance of mild or moderate renal dysfunction in 79 patients who have undergone repair of an infrarenal abdominal aortic aneurysm at our institution.

Methods : The postoperative results of 35 non-dialysis-dependent patients (Group I) with renal dysfunction were included and compared with a group of 44 patients (Group II) with similar characteristics of age, gender and pre-operative risk factors. All operations were performed through a standard transperitoneal median laparotomy. Results : The mean operation and aortic cross-clamp times did not differ significantly between the two groups (234 ± 15 min vs. 189 ± 17min; p = 0.25 and 57 ± 12 min. vs. 52 ±9 min.; p = 0.52). Early operative mortality was 5.71% in patients with renal dysfunction and did not differ significantly when compared with the other group of patients 4.5%; p = 0.083). Blood requirement was higher (p < 0.01) and the hospital stay was longer (p < 0.001) in group I. There were 18 patients in group I (51.4%) and three patients in group II (6.8%) in whom the pre-operative serum creatinine level increased above 2.5 mg/dl during the postoperative period. The postoperative increase of creatinine level differed significantly in patients with pre-operative renal dysfunction (p < 0.001). There were nine patients (25.7%) in group I and four patients (9.1%) in group II who required mechanical ventilation for more than 24 hours (p = 0.025). There was no significant difference between the two groups in terms of cardiac morbidity p = 0.234).

Conclusion : Patients with even a mild or moderate degree of renal dysfunction require close monitoring and prolonged hospital care during the postoperative period. Although satisfactory early surgical outcomes may be expected in this particular group of patients, pulmonary and renal morbidity rates are higher than in patients with normal renal function.