title: Comparison of outcomes for open abdominal aortic aneurysm repair and endovascular repair in patients with chronic renal insufficiency.
abstract: OBJECTIVE
  This study investigates whether this practice is supported by multicenter prospectively collected data.
  
  
  BACKGROUND
  Currently, open abdominal aortic aneurysm (AAA) repair (OPEN) is preferred over endovascular repair (EVAR) in patients with chronic renal insufficiency because of the concern that the contrast load used for EVAR may result in postoperative dialysis.
  
  
  METHODS
  Patients who underwent EVAR and OPEN for infrarenal AAA were identified in the NSQIP database from 2005 to 2010. Preoperative renal function was assessed by estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration equation. Patients with chronic renal insufficiency were further stratified into 2 different groups: moderate (eGFR = 30-60 mL/min) and severe (eGFR <30 mL/min) renal dysfunction. Multivariate regression model was used for data analysis.
  
  
  RESULTS
  We identified 13,191 patients who underwent AAA repair: 9877 patients underwent EVAR and 3314 underwent OPEN. Forty percent of patients had eGFR of less than 60 mL/min. OPEN in patients with moderate renal dysfunction resulted in significantly higher mortality, cardiovascular events, and combined outcomes. However, in patients with severe renal dysfunction, these outcomes were similarly high in both OPEN and EVAR. Most importantly, OPEN in patients with moderate renal dysfunction resulted in 5.2 times higher risk of dialysis.
  
  
  CONCLUSIONS
  Contrary to current practice, and despite the use of contrast, EVAR should be the first choice in patients with moderate renal dysfunction if they have the appropriate anatomy. Higher threshold for AAA repair with either OPEN or EVAR should be applied in patients with severe renal dysfunction because postoperative complications were significantly high with either approach.
authors.affiliation: Department of Surgery, George Washington University, Washington, DC.
authors.forename: Bao-Ngoc
authors.initials: BN
authors.lastname: Nguyen
authors.forename: Richard F
authors.initials: RF
authors.lastname: Neville
authors.forename: Rodeen
authors.initials: R
authors.lastname: Rahbar
authors.forename: Richard
authors.initials: R
authors.lastname: Amdur
authors.forename: Anton N
authors.initials: AN
authors.lastname: Sidawy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome