SS09. Impact of Acute Kidney Injury on Long-Term Outcomes Following Fenestrated and Branched Endovascular Aneurysm Repair

Abstract

Fenestrated and branched endovascular aortic repair (F/B-EVAR) is a transformative, minimally invasive technology used for the treatment of complex aortic aneurysms. Acute kidney injury (AKI), occurring in 5% to 25% of patients, has been identified as a common complication following F/B-EVAR. Predictors of AKI and its impact on long-term outcomes remain unknown. Therefore, we sought to identify independent predictors of AKI and its effect on long-term survival following F/B-EVAR. A single-institution retrospective review of all consecutive F/B-EVAR was performed (November 2010 to September 2018). Data were collected prospectively through an institutional review board-approved registry and a physician-sponsored investigational device exemption clinical trial (G130210). AKI was defined as a decrease in estimated glomerular filtration rate by more than 30% from baseline, within 30 days postoperatively. The cohort was stratified according to AKI versus no AKI. Demographics, operative details, perioperative complications, and length of stay between groups were compared. The primary outcome, long-term survival, was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling. Independent predictors of AKI were identified using logistic regression. Among 219 consecutive F/B-EVAR patients, AKI occurred in 41 patients (19%) and was the most common 30-day complication. Whereas preoperative creatinine or estimated glomerular filtration rate did not predict the risk of postoperative AKI, the occurrence of intraoperative complications did correlate with the incidence of AKI (37% vs 7.3%; P < .01). By 30 days, AKI resolved in 7 patients (17%), persisted without need for dialysis in 26 (64%), and progressed to dialysis in 5 (12%); the remaining 3 (7%) died. Survival at 30 days was significantly lower in the AKI group (92.7% vs 98.9%; P = .047), and this difference persisted at 1 year (68% vs 87%; log-rank P < .01) and 3 years (44% vs 60%, log-rank P = .04; Fig). On multivariable modeling, AKI increased the hazard of death by nearly two-fold (hazard ratio, 1.92; 95% confidence interval [CI], 1.11-3.23; P = .019). Independent predictors of AKI on multivariable logistic regression were intraoperative complications (odds ratio, 4.10; 95% CI, 1.61-10.42; P < .01) and increased operating room time (odds ratio, 1.56; 95% CI, 1.22-2.00; P < .01). In our 8-year experience of F/B-EVAR, postoperative AKI was the most common complication, observed in nearly 20% of patients. AKI after F/B-EVAR is associated with decreased short- and long-term survival. Whether AKI is causative or just associated with decreased survival remains to be elucidated. Further study is needed to determine if the independent predictors of AKI, including intraoperative complications and operating room time, are generalizable across all centers performing F/B-EVAR and to investigate how we might further mitigate this common and serious complication.