Highlights
- •Single-center, retrospective, observational cohort pilot study on patients with abdominal aortic aneurysm (AAA) and chronic kidney disease (CKD).
- •Total iodine contrast-free AAA management throughout the diagnostic, planning, surgical and follow-up stages was possible for seventeen patients treated with EVAR.
- •Patients had similar mean pre-, postoperative (at discharge) and follow-up GFRs; no graft-related complications and aneurysm- or kidney-related deaths occurred at follow-up.
- •This strategy guarantees kidney function preservation in patients with CKD without increasing the risks of EVAR treatment-related complications.
Abstract
Objectives
To retrospectively evaluate the feasibility and effectiveness of the endovascular
treatment of patients with abdominal aortic aneurysm (AAA) and chronic kidney disease
(CKD) without the need for using iodinated contrast media (ICM) throughout the diagnostic,
therapeutic and follow-up pathway.
Methods
A retrospective review of prospectively collected data concerning 251 consecutive
patients presenting an abdominal aortic or aorto-iliac aneurysm who underwent endovascular
aneurysm repair (EVAR) from January 2019 to November 2022 at our academic institution
was performed in order to identify patients with feasible anatomy with respect to
manufacturers’ instructions for use (IFU) and with CKD. Patients whose preoperative
workout included duplex ultrasound (DUS) and plain computed tomography (pCT) for pre-procedural
planning were extracted from a dedicated EVAR database. EVAR was performed with the
use of carbon dioxide (CO2) as contrast media of choice, whereas follow-up examinations consisted of either
DUS, pCT or contrast-enhanced ultrasound (CEUS). Primary endpoints were technical
success, perioperative mortality and early renal function variations. Secondary endpoints
were all-type endoleaks (EL) and reinterventions, mid-term aneurysm-related and kidney-related
mortality.
Results
Forty-five patients had CKD and were treated electively (45/251, 17.9%). Of them,
seventeen patients were managed with a total ICM-free strategy and constituted the
object of the present study (17/45, 37.8%; 17/251, 6.8%). In seven cases an adjunctive
planned procedure was performed (7/17, 41.2%). No intraoperative bail-out procedures
were needed. This extracted cohort of patients presented similar mean preoperative
and postoperative (at discharge) GFRs values, 28.14 (SD 13.09; median 28.06, IQR 20.25)
ml/min/1.73m2 and 29.33 (SD 14.61; median 27.35, IQR 22) ml/min/1.73m2 respectively (p= .210). Mean follow-up was 16.4 months (SD 11.89; median 18, IQR
23). During follow-up no graft-related complications occurred in terms of either thrombosis,
type I or III EL, aneurysm rupture or conversion. The mean GFR at follow-up was 30.39
ml/min/1.73m2 (SD 14.45; median 30.75, IQR 21.93), with no significant worsening in comparison
with pre and postoperative values (p= .327 and p= .856 respectively). No aneurysm-
or kidney-related deaths occurred during follow-up.
Conclusions
Our initial experience shows that total iodine contrast-free AAA endovascular management
in patients with CKD may be feasible and safe. Such an approach seems to guarantee
the preservation of residual kidney function without increasing the risks of aneurysm-related
complication in the early and midterm postoperative period and it could be considered
even in case of complex endovascular procedures.
KEY WORDS
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Article info
Publication history
Accepted:
February 28,
2023
Received in revised form:
February 27,
2023
Received:
January 9,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
