Comparison of modern open infrarenal and pararenal abdominal aortic aneurysm repair on early outcomes and renal dysfunction at one year

Abstract

This study was conducted to review contemporary results of elective open infrarenal abdominal aortic aneurysm (IAAA) and pararenal abdominal aortic aneurysm (PAAA) repairs and determine predictors of death and acute and 1-year renal dysfunction (RD). A retrospective review identified 432 consecutive patients undergoing open IAAA (233 patients) or PAAA (184 patients) repair between January 2000 and December 2007. Demographic, preoperative, intraoperative, and postoperative variables were collected. RD was defined as an increase in creatinine of ≥ 0.5 mg/dL from baseline. Multiple logistic regression models were used to identify predictors of mortality and RD. Mortality rates were similar between the groups (3.9% IAAA and 6.0% PAAA). Preoperative coronary artery disease (CAD), postoperative myocardial infarction, or pulmonary complications were all strong predictors of operative mortality in patients undergoing repair of PAAAs and IAAAs. However, neither PAAA nor baseline renal insufficiency was an independent predictor of death. Postoperative RD occurred in 32% of patients after PAAA repairs compared with 13% of patients after IAAA repairs (P < .001). The presence of PAAA, baseline hypertension, and hyperlipidemia all correlated positively with postoperative RD, while a trend was noted with baseline renal insufficiency (P = .09). At the 1-year follow-up, 5.1% of patients in the PAAA group had RD compared with none in the IAAA group. Similarly, the serum creatinine level was significantly higher in the PAAA group (1.4 mg/dL vs 1.2 mg/dL, PAAA and IAAA, respectively; P = .02) at 1 year. However, there were no instances of new-onset hemodialysis dependence at 1 year. Mean follow-up was 2.2 years overall. Open PAAA repair can be performed without a significant increase in mortality compared to open IAAA repair. Although the incidence of renal function deterioration after open PAAA repairs remains higher than with open IAAA repairs, the overall incidence remains low at 1-year follow-up.