title: Incidence and Outcomes of Severe Renal Impairment Following Ruptured Abdominal Aortic Aneurysm Repair.
abstract: BACKGROUND
  Acute kidney injury (AKI) following ruptured abdominal aortic aneurysm (rAAA) repair is common and multifactorial. A standard definition of AKI after endovascular repair (EVAR), the Aneurysm Renal Injury Score (ARISe), has been proposed to facilitate standardised reporting and thus improve understanding of this issue.
  
  
  METHODS
  Data were collected retrospectively on AKI in a prospectively maintained database of all patients treated for rAAA in a single tertiary referral centre since the availability of routine out of hours emergency EVAR. The ARISe score was used to describe the degree of AKI and factors which correlated with poor renal outcomes were assessed.
  
  
  RESULTS
  Two-hundred and five patients were treated between January 2006 and April 2014. Of these, 125 were treated with open repair (OSR) and 80 were treated with EVAR. Severe AKI (defined as ARISe score ≥3) occurred in 36% of patients. After correction for confounders, patients treated with OSR were significantly more likely to develop severe AKI (43% vs. 26%, p = .02). There was no significant difference in preoperative serum creatinine between groups, but increased preoperative serum creatinine was strongly associated with severe AKI postoperatively (p < .001). Age, sex, endograft type, and preoperative CT scanning were not associated with differences in renal outcomes. Clamp position above renal arteries was predictive of severe AKI in patients treated with OSR (p < .01). Patients suffering severe AKI had significantly higher mortality at 30 days and 12 months (28% vs. 5% and 44% vs. 13%, p < .001 for both comparisons).
  
  
  CONCLUSIONS
  Severe AKI is common following successful repair of rAAA. In this large case series of high-risk patients, OSR was associated with significantly higher rates of severe AKI compared with EVAR, despite the increased dose of contrast involved in EVAR and the older age of these patients. In turn, severe AKI was associated with higher mortality rates.
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: graeme.ambler@gmail.com.
authors.forename: G K
authors.initials: GK
authors.lastname: Ambler
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Coughlin
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Hayes
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: K
authors.initials: K
authors.lastname: Varty
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Gohel
authors.affiliation: Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Boyle
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D003404:Creatinine / Q000097:blood; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Abdominal; Acute kidney injury; Aortic aneurysm; Survival analysis