Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury.

Abstract

Patients undergoing endovascular aneurysm repair (EVAR) have comorbidities that increase the risk of death, myocardial infarction (MI) and acute kidney injury (AKI). Our aim was to evaluate the incidence and predictors of mortality, MI and AKI after EVAR and to compare AKI incidence with Vascular Surgery Kidney Injury Predictive Score (VSKIPS). We conducted a retrospective study of EVAR procedures performed between March 2006 and November 2013. We defined mortality at 30 days, MI as an increase in troponin level to >0.034 ng mL-1 in the first 72 h and AKI as an increase in creatinine level to >0.3 mg dL-1 in the first 48 h after surgery. Risk factors were analysed using logistic regression calculating Hosmer-Lemeshow test and the area under the receiver operating curve (AUROC). Ninety-eight patients were included in the study. The incidence of mortality, MI, and AKI was 2%, 5%, and 18%, respectively. AKI increased the risk of MI [odds ratio (OR) 24.4, p=0.006]. Preoperative serum urea level of >50 mg dL-1 (OR 4.97, p=0.038), general anaesthesia (OR 9.64, p=0.002) and surgery duration (OR 1.53, p=0.043) were considered independent predictors of AKI. The AUROC of the AKI model was 0.886 compared with 0.793 of VSKIPS. We found the incidence of mortality, MI and AKI consistent with that of previous studies. However, we may be underestimating the last two because of the short follow-up time. AKI was an independent predictor of MI. Preoperative serum urea level of >50 mg dL-1, general anaesthesia and surgery duration were considered independent predictors of AKI.