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Titolo:
Endovascular AAA repair in patients with renal insufficiency: strategies for reducing adverse renal events
Autore:
Carpenter, JP; Fairman, RM; Barker, CF; Golden, MA; Velazquez, OC; Mitchell, ME; Baum, RA;
Indirizzi:
Univ Penn, Sch Med, Dept Surg, Philadelphia, PA 19104 USA Univ Penn Philadelphia PA USA 19104 Dept Surg, Philadelphia, PA 19104 USA Univ Penn, Sch Med, Dept Radiol, Philadelphia, PA 19104 USA Univ Penn Philadelphia PA USA 19104 pt Radiol, Philadelphia, PA 19104 USA
Titolo Testata:
CARDIOVASCULAR SURGERY
fascicolo: 6, volume: 9, anno: 2001,
pagine: 559 - 564
SICI:
0967-2109(200112)9:6<559:EARIPW>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
ABDOMINAL AORTIC-ANEURYSMS; CARBON-DIOXIDE ANGIOGRAPHY; DIGITAL SUBTRACTION ANGIOGRAPHY; MAGNETIC-RESONANCE ANGIOGRAPHY; 3-DIMENSIONAL MR-ANGIOGRAPHY; CT ANGIOGRAPHY; STENT-GRAFT; CONTRAST; PLACEMENT; ARTERIOGRAPHY;
Keywords:
magnetic resonance angiography; gadolinium; angiography; stents;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Carpenter, JP Univ Penn, Sch Med, Dept Surg, 4 Silverstein,3400 Spruce St,Philadelphia,PA 19104 USA Univ Penn 4 Silverstein,3400 Spruce St Philadelphia PA USA 19104
Citazione:
J.P. Carpenter et al., "Endovascular AAA repair in patients with renal insufficiency: strategies for reducing adverse renal events", CARDIOV SUR, 9(6), 2001, pp. 559-564

Abstract

Vascular imaging, usually employing nephrotoxic contrast agents is relied upon for all aspects of endovascular AAA repair causing some to consider renal insufficiency a relative contraindication. We sought to determine if endovascular AAA evaluation and repair could be successfully accomplished by minimally or non-nephrotoxic modalities. Records and results for 98 consecutive patients undergoing endovascular AAA repair were reviewed. Patients requiring dialysis preoperatively were excluded (N = 3). The average volume of iodinated contrast agent employed for intraoperativeimaging was 152 cc (35-420 cc). Twenty patients (20%) had baseline renal insufficiency (serum creatinine greater than or equal to1.3 mg/dl). A rise in serum creatinine above baseline was observed in 23 (24%) patients following repair; for 15 (16%) this was permanent. Creatinine rise occurred in patients with both normal (15) and abnormal (8) baseline values (P = 0.09). Rise in creatinine was independent of contrast volume employed and of the useof infrarenal vs suprarenal device fixation (P >0.05). Two (2%) patients required permanent dialysis, one of which had a normal baseline creatinine and unclear etiology for renal failure, the other had a baseline creatinine of 2 and required device placement over an accessory renal artery. Strategies to minimize the use of nephrotoxic contrast for patients with renal insufficiency included the use of MRA, rather than contrast-CT for pre and postoperative imaging (7, 35%) and use of Gadolinium rather than iodinated contrast for performance of intraoperative arteriography (5. 25%). Endovasculargrafts were successfully designed and implanted based upon MRA as the solepreoperative imaging modality in every case in which it was attempted (7). Mortality was not significantly different between those with and without abnormal baseline renal function (P>0.05). Adverse events (access failures, arterial injuries, blood loss, endoleaks) were not significantly correlatedwith baseline renal insufficiency, rise in creatinine from baseline, use of MRA or intraoperative Gadolinium angiography (P >0.05). Pre- and postoperative evaluation and performance of endovascular AAA repair can be accomplished in patients with renal insufficiency without increasing the rate of mortality or adverse events employing a strategy which minimizes the use of nephrotoxic contrast agents, relying upon Gadolinium arteriography and MRA. Endovascular grafts can be successfully planned and followed employing MRA as the sole imaging modality. (C) 2001 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/10/20 alle ore 12:29:45