title: Endovascular treatment of complex aortic aneurysms: prevalence of acute kidney injury and effect on long-term renal function.
abstract: OBJECTIVE
  To analyse predictors for short- and long-term renal function changes after fenestrated and branched endovascular aortic repair (EVAR).
  
  
  METHODS
  A total of 157 patients underwent fenestrated and branched EVAR. Procedural intra-arterial iodinated contrast volume was documented. Serum creatinine and estimated glomerular filtration rate (eGFR) at baseline, during 48 h following EVAR, at discharge and latest moment of follow-up were recorded. Development of post-EVAR acute kidney injury (AKI; according to AKIN criteria), and potential risk factors for renal failure were recorded. Multivariate regression analyses were used to identify independent risk factors for AKI and eGFR decrease during follow-up.
  
  
  RESULTS
  Forty-three patients (28 %) developed post-EVAR AKI. Long procedure time and occlusion of accessory renal arteries were independent risk factors for development of AKI. (odds ratio (OR) 1.005 per minute, 95 % CI 1.001-1.01; p = 0.025 and OR 3.02, 95 % CI 1.19-8.16; p = 0.029). Post-EVAR AKI was associated with a significantly increased risk for eGFR decrease at discharge and latest follow-up (hazard ratio (HR) 3.47, 95 % CI 1.63-7.36, p = 0.001 and HR 3.01, 95 % CI 1.56-5.80; p = 0.001). Iodinated contrast volume was not an independent risk factor for AKI or eGFR decrease during follow-up.
  
  
  CONCLUSIONS
  Development of post-EVAR AKI is an independent risk factor for long-term renal function decrease.
  
  
  CONCLUSIONS
  • Longer procedure time is associated with an increased risk for AKI. • Renal perfusion defects on angiography are associated with increased risk for AKI. • Post-EVAR AKI is associated with higher probability for long-term eGFR decrease. • Iodinated contrast volume is not an independent risk factor for AKI. • Iodinated contrast volume is not an independent risk factor for long-term eGFR decrease.
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. karmanna@stanford.edu.|Department of Radiology, Stanford University Hospitals and Clinics, Stanford, CA, USA. karmanna@stanford.edu.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sailer
authors.affiliation: Department of Epidemiology, Maastricht University Medical Centre, Maatsricht, The Netherlands.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Nelemans
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Camille
authors.initials: C
authors.lastname: van Berlo
authors.affiliation: Department of Vascular Surgery, Cliniques del Europe, Brussels, Belgium.
authors.forename: Ozan
authors.initials: O
authors.lastname: Yazar
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Michiel W
authors.initials: MW
authors.lastname: de Haan
authors.affiliation: Department of Radiology, Stanford University Hospitals and Clinics, Stanford, CA, USA.
authors.forename: Dominik
authors.initials: D
authors.lastname: Fleischmann
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Geert Willem H
authors.initials: GW
authors.lastname: Schurink
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications*; D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications* / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013995:Time; D016896:Treatment Outcome
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Aortic aneurysm; Contrast media; Endovascular procedures; Glomerular filtration rate