Endovascular vs open AAA repair: similar effects on renal proximal tubular function.
OBJECTIVE
To compare the effect of open and endovascular repair on renal function.


METHODS
In a prospective, non-randomized study twenty-four abdominal aortic aneurysms (AAA) treatable with either method were repaired, 15 using endovascular device (ENDO group) and nine with open surgery with infrarenal aortic cross-clamping (OPEN group). All the patients had standardised general anaesthesia, intravascular fluid therapy and monitoring. Renal function tests and cardiovascular measurements were performed at predetermined intervals.


RESULTS
N-acetyl-beta-D-glucosaminidase indexed to urinary creatinine (U-NAG/crea), a sensitive marker of renal proximal tubular damage, increased similarly in both groups at the end of surgery (two-way ANOVA, p < 0.05). No patient developed clinical renal impairment, on the contrary, creatinine clearance was increased, serum cystatin C (a sensitive marker of renal glomerular filtration) and serum creatinine concentration decreased at 24 hours postoperatively (Wilcoxon paired test, p < 0.05). Intraoperative blood loss and the amount of administered crystalloids were higher in the OPEN than in the ENDO group (Mann-Whitney U-test, p < 0.05). The cardiovascular measurements were comparable between the groups. The mean (SD) amount of radio-contrast media given was 3.1 (1.1) ml/kg in the ENDO group.


CONCLUSIONS
Our results indicate that endovascular AAA repair does not protect renal proximal tubular function. A temporary renal tubular dysfunction was found both in open and in endovascular AAA repair which did not lead to permanent changes in renal function.
Aho
P S
PS
Department of Vascular Surgery, Helsinki University Central Hospital, Finland. pekka.aho@hus.fi
Niemi
T
T
Lindgren
L
L
Lepäntalo
M
M
D000118:Acetylglucosaminidase / Q000652:urine; D000368:Aged; D000704:Analysis of Variance; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood / Q000652:urine; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine; D000118:Acetylglucosaminidase; D012083:Renin