Abdominal aorta surgical intervention and acute renal injury

The OBJECTIVE of this scientific research was to study risk factors, frequency and consequences of acute kidney injury (AKI) after open surgery on the abdominal aorta.

METHODS AND MATERIALS. Outcome of surgical interventions in 65 patients were analyzed. AKI was detected in 11 of them; in rest 54 cases, AKI was not registered. The features of the perioperative period, kidney injury markers (creatinine, diuresis, urine), and the comorbidity were evaluated.

RESULTS. The initial changes in renal activity, the emergency of intervention, hemodynamic instability, especially after more than 1000 ml perioperative blood loss, the presence of operations for multilevel peripheral arterial disease (MPAD) negatively affected on the AKI occurrence.

CONCLUSION. Post-surgical AKI after infrarenal aortic interventions were observed more often in patients with previous kidney insufficiency, as well as after emergency interventions, in cases of hemodynamic instability.

1. Chang C. K., Chuter T. A. M., Niemann C. U., Shlipak M. G., Cohen M. J., Reilly L. M., Hiramoto J. S. Systemic inflammation, coagulopathy, and acute renal insufficiency following endovascular thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery. 2009;49(5):1140–1146. Doi: 10.1016/j.jvs.2008.11.102.

2. Castagno C., Varetto G., Quaglino S., Frola E., Scozzari G., Bert F., Rispoli P. Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms. Journal of Vascular Surgery. 2016;64(4):928–933. Doi: 10.1016/j.jvs.2016.02.048.

3. Tang Y., Chen J., Huang K., Luo D., Liang P., Feng M., Chai W., Fung E., Lan H. Y., Xu A. The incidence, risk factors and in – hospital mortality of acute kidney injury in patients after abdominal aortic aneurysm repair surgery. BMC Nephrology. 2017 May. Doi: 10.1186/s12882-017-0594-6.

4. Ellenberger C., Schweizer A., Diaper J., Kalangos A., Murith N., Katchatourian G. et al. Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery. Intensive Care Medicine. 2006;32(11):1808–1816. Doi: 10.1007/s00134-006-0308-1.

5. Glushkov N. I., Ivanov M. А., Puzdryak P. D., Artemova A. S., Lysenko K. S., Sukhareva Yu. V., Bondarenko P. В. Choice of the revascularization method for patients with multi-level lesion of lower limb arteries. Clin Experiment Surg. Petrovsky J. 2019;7(1):62–68. Doi: 10.24411/2308-1198-2019-11008. (In Russ.).

6. Wahlberg E., DiMuzio P. J., Stoney R. J. Aortic clamping during elective operations for infrarenal disease: The influence of clamping time on renal function. Journal of Vascular Surgery. 2002;36(1):13–18. Doi: 10.1067/mva.2002.123679.

7. Cherr G. S., Hansen K. J., Craven T. E., Edwards M. S., Ligush J., Levy P. J. et al. Surgical management of atherosclerotic renovascular disease. Journal of Vascular Surgery. 2002;35(2):236–245. Doi: 10.1067/mva.2002.120376.

8. Glushkov N. I., Ivanov M. A., Apresyan A. Yu. et al. Influence of the metabolic syndrome on the results of the reconstructions in patients with infraingvinal artery deasease. Herald of the North – Western State Medical University named after I. I. Mechnikov. 2018;10(3):54–59. Doi: 10.17816/mechnikov201810354-59. (In Russ.).

9. Tallgren M., Niemi T., Pöyhiä R., Raininko E., Railo M., Salmenperä M. et al. Acute Renal Injury and Dysfunction Following Elective Abdominal Aortic Surgery. European Journal of Vascular and Endovascular Surgery. 2007;33(5):550–555. Doi: 10.1016/j.ejvs.2006.12.005.

10. Brienza N., Giglio M. T., Marucci M., Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Critical Care Medicine. 2009;37(6):2079–2090. Doi: 10.1097/ccm.0b013e3181a00a43.

11. Grant S. W., Grayson A. D., Grant M. J., Purkayastha D., McCollum C. N. What are the Risk Factors for Renal Failure following Open Elective Abdominal Aortic Aneurysm Repair? European Journal of Vascular and Endovascular Surgery. 2012;43(2):182–187. Doi: 10.1016/j.ejvs.2011.11.018.

12. Ricci Z., Ronco C., D’amico G., De Felice R., Rossi S., Bolgan I. et al. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrology Dialysis Transplantation. 2005;21(3):690–696. Doi: 10.1093/ndt/gfi296.

13. Barratt J., Parajasingam R., Sayers R. D., Feehally J. Outcome of acute renal failure following surgical repair of ruptured abdominal aortic aneurysms. European Journal of Vascular and Endovascular Surgery. 2000;20(2):163–168. Doi: 10.1053/ejvs.2000.1078.