Postoperative renal complications following open juxtarenal aortic aneurysm repair adversely impact midterm survival

Abstract

Objective

Juxtarenal aortic aneurysms present a challenge for endovascular treatment. Although renal dysfunction after open repair has been associated with lower short-term survival, the relationship between postoperative kidney function and midterm outcomes such as rupture, reintervention, and mortality remains unclear. This study investigates the association between postoperative renal function and these outcomes.

Methods

We conducted a retrospective cohort study using data from the Society for Vascular Surgery Vascular Quality Initiative linked to Medicare claims through the Vascular Implant Surveillance and Interventional Outcomes Network (VISION). Patients who underwent elective open repair of juxtarenal aortic aneurysms between January 2003 and December 2018 (N = 1925) were included. Patients were stratified based on postoperative renal function: stable renal function; acute kidney injury (AKI), as defined by a ≥0.5 mg/dL increase in baseline serum creatinine level; or need for renal replacement therapy (RRT). Primary outcomes included 5-year mortality, rupture, and reintervention, and secondary outcomes were immediate postoperative complications. Multivariable logistic regression, Kaplan-Meier analysis, and Cox regression modeling were used.

Results

Among the 1925 patients, 74% had stable postoperative renal function, 21% developed AKI, and 4.9% required RRT. Worse renal outcomes were associated with longer renal ischemia times, higher proximal aortic clamping, and renal artery bypass. Postoperative, 30-day mortality was highest in the RRT group, along with higher rates of cardiac, respiratory, and intestinal ischemic complications (P < .001). Patients requiring RRT had higher risks of subsequent aortic aneurysm-related reintervention (adjusted hazard ratio [aHR]: 2.4; 95% confidence interval [CI]: 1.1-5.1; P = .03) and midterm (1-, 3-, and 5-year follow-up) mortality (aHR: 2.2; 95% CI: 2.1-5.1; P < .001) compared with those with stable renal function. Patients with AKI also had higher midterm mortality (aHR: 1.5; 95% CI: 1.1-2.0; P = .01). No significant differences in aneurysm rupture were observed between groups.

Conclusions

Postoperative patients who required RRT were associated with increased midterm aortic reinterventions and mortality after open juxtarenal aneurysm repair. Patients demonstrating any degree of renal impairment were associated with higher midterm mortality risk, though rupture rates and rates of reintervention demonstrated no difference.