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Outcomes for Abdominal Aortic Aneurysm (AAA) Repair in Patients with Chronic Renal Insufficiency (CRI): Comparison between Endovascular Repair (EVAR) and Open Resection (OPEN)
Bao-Ngoc H Nguyen*, Richard Neville*, Rodeen Rahbar*, Richard Amdur*, Anton Sidawy
George Washington University, Washington, DC

OBJECTIVE(S): Currently, OPEN is preferred over EVAR in patients with CRI because of the concern that the contrast load used for EVAR may result in post-operative dialysis. This study investigates whether this practice is supported by multicenter prospectively-collected data.
METHODS: Patients who underwent EVAR and OPEN for infra-renal AAA were identified in the NSQIP database from 2005-2010. Pre-operative renal function was assessed by estimated-GFR calculated by the CKD-EPI equation. Patients with CRI were stratified into two different groups: moderate (eGFR 30-60ml/min) and severe (eGFR<30ml/min) renal dysfunction. Multivariate regression model was used for data analysis.
RESULTS: We identified 13191 patients who had AAA repair; 9877 patients received EVAR and 3314 underwent OPEN. Forty percent had eGFR<60ml/min. OPEN in patients with moderate renal dysfunction resulted in significantly higher mortality, cardiovascular events, and combined outcomes. However, in patients with severe renal dysfunction, the above outcomes were similarly high in both OPEN and EVAR. Most importantly, OPEN in patients with moderate renal dysfunction resulted in 5.2 times higher risk of dialysis (table).
CONCLUSIONS: Contrary to current practice and despite the use of contrast, EVAR should be the first choice in patients with moderate renal dysfunction if they have appropriate anatomy. Higher threshold for AAA repair with either OPEN or EVAR should be applied in patients with eGRF<30ml/min because post-operative complications were significantly high with either approach.


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