title: Frequency and outcomes of acute renal failure following thoracic aortic stent-graft placement.
abstract: We assessed the incidence, correlates, and outcomes of acute renal failure (ARF) after thoracic aortic stent-graft placement. Postprocedural ARF is an inherent complication of catheter-based interventional procedures that use intra-arterial contrast agents and has adverse effects on short- and long-term outcomes. However, few data exist on the incidence, predictors, and outcomes of ARF after thoracic aortic stent-graft placement. We analyzed data of 97 patients (64.4 +/- 11.6 years of age; 73% men) who underwent thoracic aortic stent-graft placement from July 1999 to October 2005. Postprocedural ARF was defined as an increase > or = 25% and/or > or = 0.5 mg/dl in preprocedural serum creatinine at 48 hours after the procedure. Baseline estimated glomerular filtration rate was 65 +/- 24 ml/min/1.73 m2. Chronic kidney disease (glomerular filtration rate < or = 60 ml/min/1.73 m2) at baseline was present in 45% of patients. During the stent-graft procedure, patients received 307 +/- 188 ml of nonionic contrast medium. Postprocedural ARF occurred in 33 patients (34%), and 3 required dialysis. Multivariable analysis identified American Society of Anesthesiologists class > 3 (odds ratio 5.53, 95% confidence interval 1.71 to 17.85, p = 0.004) and duration of the stent-graft procedure (odds ratio 1.01, 95% confidence interval 1.001 to 1.014, p = 0.022) as independent predictors of postprocedural ARF. Compared with patients without ARF, those with ARF had markedly higher 30-day (18.2 +/- 6.7% vs 1.6 +/- 1.6%, p = 0.0022) and 1-year (35.2 +/- 8.6% vs 10.1 +/- 3.9%, p = 0.001) mortality. In conclusion, postprocedural ARF is a frequent complication of thoracic aortic stent-graft placement and has a significant adverse effect on 30-day and 1-year survival. Baseline factors identified in our study as associated with increased risk of ARF may facilitate a comprehensive informed consent process by way of patient education. In addition, identification of an at-risk subset may allow modification of reversible periprocedural factors that may help decrease postprocedural ARF.
authors.affiliation: The Department of Cardiology, West-German Heart Center Essen, Essen, Germany. holger.eggebrecht@uni-essen.de
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Frank
authors.initials: F
authors.lastname: Breuckmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Martini
authors.forename: Dietrich
authors.initials: D
authors.lastname: Baumgart
authors.forename: Ulf
authors.initials: U
authors.lastname: Herold
authors.forename: Peter
authors.initials: P
authors.lastname: Kienbaum
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate