title: Is Endovascular Aneurysm Repair a Relative Contraindication for Patients with Preoperative Renal Dysfunction?
abstract: Whether endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is a relative contraindication in patients with preoperative renal dysfunction (Pre-RD), remains controversial because the contrast medium may induce nephrotoxicity. In this study 1658 patients were treated at ten Japanese medical centers between January 2005 and March 2011 (Open surgery (OS) vs. EVAR: n = 1270 vs. n = 388). They were retrospectively analyzed. Multiple logistic regression analysis (MLRA) with pre- and intra-operative variables was applied to all patients. The endpoints induced onset of new dialysis and postoperative renal dysfunction (Post-RD), were defined as a 50% decrease or more from the preoperative estimated glomerular filtration rate (eGFR) level.
  
  
  RESULTS
  Early mortality, Post-RD, incidence of new dialysis in all patients were 1.6% (OS: EVAR = 1.9%:0.8%), 6% (OS: EVAR = 8%:2.3%) and 1.4% (OS: EVAR = 1.5%:1.0%) respectively. MLRA identified operation time, clamp of renal artery as risk factors for Post-RD, and operation time and Pre-eGFR level as risk factors for new dialysis.
  
  
  CONCLUSIONS
  Although Post-RD was more frequently observed in the OS group, MLRA showed that the choice of OS or EVAR was not a risk factor for Post-RD and new dialysis. It was strongly suggested that using contrast medium during EVAR is not a contraindication to AAA repair in patients with Pre-RD. (This article is a translation of J Jpn Coll Angiol 2014; 54: 13-18.).
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Furuyama
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Onohara
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Keita
authors.initials: K
authors.lastname: Mikasa
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Jyunji
authors.initials: J
authors.lastname: Kishimoto
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Minoru
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shimoe
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Okada
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Ishibashi
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Mikizou
authors.initials: M
authors.lastname: Nakai
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Suhara
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Fuminari
authors.initials: F
authors.lastname: Kasashima
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Endo
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishina
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Jyunichi
authors.initials: J
authors.lastname: Kei
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Mizuno
authors.affiliation: National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Handa
keywords: EVAR; abdominal aortic aneurysm; eGFR; open surgery; renal function