Endovascular Repair of Ruptured Abdominal Aortic Aneurysm Is Associated with Lower Incidence of Post-operative Acute Renal Failure

Abstract

Background: Acute renal failure (ARF) after surgical treatment of ruptured abdominal aortic aneurysm (AAA) is an independent predictor of post-operative mortality. Open repair for ruptured AAA has been the gold standard treatment; however, there has been a recent trend in increased utilization of endovascular repair (EVAR) for treatment of ruptured AAA. The purpose of this study was to retrospectively review and compare the incidence of ARF among patients treated with open versus endovascular repair of ruptured AAA.

Methods: American College of Surgeons National Surgical Quality Improvement Program database was searched for surgeries performed for AAA during 2005-2010. Patients' demographics and co-morbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, myocardial infarction, peripheral arterial disease) were collected. Incidence of ARF after surgery was reviewed. We also collected American Society for Anesthesiologists scores, operating times, functional status, post-operative complications, and mortality.

Results: Of total 2179 operations for ruptured AAA, incidence of mortality within first 30 days after operation was 17% after EVAR for ruptured AAA and 33.2% after open repair of ruptured AAA. Incidence of ARF was 6.9% after EVAR for ruptured AAA and 13.5% after open repair of ruptured AAA. Odds ratio for mortality after open repair was 1.94 (confidence interval [CI] 1.51-2.49) when compared with EVAR (P < 0.001), and odds ratio for developing ARF after EVAR was 1.62 (CI 1.14-2.29) as compared with open AAA repair (P < 0.05) in multivariable logistic regression models. Open repair of ruptured AAA and totally dependent functional status were associated with post-operative mortality and ARF.

Conclusions: Incidence of mortality and post-operative ARF for ruptured AAA is significantly higher when treated with open repair, as compared to EVAR. Totally dependent functional status was associated with post-operative mortality and ARF.