Advancements in preventing post-contrast acute kidney injury in EVAR: clinical strategies and future directions.

Abstract

Abdominal Aortic Aneurysm (AAA) represents a signif i cant global health issue with a high risk of rupture, resulting in substantial mortality rates. Endovascular Aneurysm Repair (EVAR) has emerged as the preferred treatment method due to its minimally invasive nature. However, the procedure carries a risk of acute kidney injury (AKI), particularly post-contrast acute kidney injury (PC-AKI), which can adversely af f ect patient outcomes. This review examines the incidence, pathophysiology, and prevention strategies for PC-AKI in the context of EVAR. It synthesizes current research on the mechanisms underlying PC-AKI, such as renal vasoconstriction, oxidative stress, and tubular toxicity. The ef f ectiveness of various preventive measures, including pre-procedural hydration, use of low-osmolality contrast agents, and alternative imaging techniques, is evaluated. Additionally, the review explores patient-specif i c risk factors and the potential of novel pharmacologic interventions. The incidence of PC-AKI in EVAR varies based on procedural complexity and patient-specif i c factors like preexisting renal insuf f i ciency, diabetes, and hypertension. Preventive strategies such as intravenous hydration and the use of less nephrotoxic contrast agents have shown ef f ectiveness. Advances in imaging technology and innovative pharmacologic interventions, including antioxidants and vasodilatory drugs, present promising approaches to reducing the risk of PC-AKI. Ef f ective management of PC-AKI in EVAR necessitates a comprehensive and multifaceted approach that considers both procedural and patient-specif i c factors. Future research should aim to standardize diagnostic criteria, ref i ne preventive strategies, and explore novel therapies. Enhanced understanding of PC-AKI pathophysiology and personalized preventive measures can improve patient safety and outcomes in EVAR procedures.