Endovasküler Abdominal Aorta Anevrizma Onarımı Sonrası Akut Böbrek Hasarının Değerlendirilmesi

Abstract

Giriş: Bu çalışmanın amacı, endovasküler abdominal aort anevrizması onarımı sonrası akut böbrek hasarı prevalansını belirlemek ve risk faktörlerini incelemektir.

Hastalar ve Yöntem: Kasım 2013-Mart 2019 tarihleri arasında abdominal aort anevrizması nedeniyle endovasküler onarım yapılan hastalar geriye dönük olarak incelendi. Acil onarım yapılan rüptüre abdominal aort anevrizmaları ve endovasküler onarımın yanı sıra renal veya iliyak çıplak stentleme gibi endovasküler işlemler uygulanan hastalar çalışma dışı bırakıldı. İşlemsel kısıtlamalar hariç; diyalize bağımlı ve akut böbrek hasarı olan hastalar ve veri eksikliği olan hastalar çalışmaya dahil edilmedi. Akut böbrek hasarı tanısı böbrek hastalığına; global sonuçlar iyileştirilmesi tanımına göre konuldu.

Bulgular: Yüz seksen beş hastaya abdominal aort anevrizmaları için elektif olarak endovasküler onarım yapılmış ve 167 hasta çalışmaya dahil edilmiştir. Hastane içi mortalite veya yeniden girişim olmamıştır. Yirmi üç (%13.8) hastada akut böbrek hasarı gelişmiş ve bu hastaların 6 (%3.3)’sında hemodiyaliz gerekmiştir. Endovasküler onarım sonrası hemodiyalize ihtiyaç duyan hastaların ameliyat öncesi böbrek fonksiyonları, hemodiyalize ihtiyaç duymayanlara göre anlamlı derecede bozuk saptanmıştır [p< 0.001; CI (25.79-61.62)].

Sonuç: Yeni akut böbrek hasarı tanımları ile endovasküler anevrizma onarımına bağlı akut böbrek hasarı sıklığı beklenenden çok daha yüksektir. Endovasküler onarımdan sonra akut böbrek hasarı geliştiyse, kalıcıdır ve hastalar böbrek fonksiyonu açısından yakından izlenmelidir.  

Keywords

• Böbrek yetmezliği
• endovasküler prosedürler
• abdominal aort anevrizmaları
• akut böbrek hasarı

Acute Kidney Injury After Endovascular Repair of Abdominal Aortic Aneurysm

Abstract

Introduction: The aim of this study is to determine the prevalence of acute kidney injury after endovascular repair of an abdominal aortic aneurysm and examine the risk factors. Patients and Methods: Patients who underwent endovascular repair of abdominal aortic aneurysms between November 2013 and March 2019 were examined retrospectively. We have excluded the patients who had ruptured abdominal aortic aneurysms and were undergoing emergency repair and those who underwent endovascular procedures, such as renal or iliac stenting, in addition to endovascular repair. Other than procedural exclusion criteria, patients dependent on dialysis, those having acute kidney injury and those with missing data were not included in the study. The acute kidney injury was diagnosed in patients according to Kidney Disease: Improving Global Outcomes definition. Results: Out of 185 patients who underwent elective endovascular repair of abdominal aortic aneurysms, 167 patients were included in this study. There was no in-hospital mortality or requirement of reintervention. An acute kidney injury developed in 23 (13.8%) patients and 6 (3.3%) of these patients needed hemodialysis. The preoperative renal functions of patients who needed hemodialysis after the endovascular repair were significantly impaired than those who did not need hemodialysis [p< 0.001; CI (25.79-61.62)]. Conclusion: With new acute kidney injury definitions, the frequency of endovascular aneurysm repair-related acute kidney injury is much higher than expected. If acute kidney damage has developed after an endovascular repair, it is permanent and patients should be closely monitored for renal function.

Keywords

• Renal failure
• endovascular procedures
• abdominal aortic aneurysms
• acute renal injury

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