OUTCOMES FOLLOWING ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR IN PATIENTS RECEIVING CHRONIC KIDNEY REPLACEMENT THERAPY

Introduction:

Endovascular aortic repair (EVAR) has a well-established role in the management of abdominal aortic aneurysm (AAA). The decision to intervene is based upon an assessment of the risk of rupture of a known aneurysm versus the risks associated with procedural intervention. The risk profile of patients with end-stage kidney disease (ESKD) with AAA is likely to be different to the population at large. Our study aims to define the rates of mortality and specific nonfatal complications in patients with ESKD undergoing EVAR in Australia and New Zealand.

Methods:

A retrospective bi-national data linkage between the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and state-based health-related datasets identified patients receiving chronic kidney replacement therapy (KRT) who underwent EVAR for AAA between 1 January 2000 and 31 December 2015. Linked data were interrogated to define patient demography, modality of KRT, date of death, and the occurrence of specific nonfatal complications. Patients were categorised by modality (haemodialysis (HD), peritoneal dialysis (PD), home haemodialysis (HHD), and kidney transplant (KT)), and logistic regression analysis was used to determine the rates of 30-day and 12-month mortality, as well as several nonfatal postoperative complications.

Results:

During the study period, 367 patients receiving KRT underwent 397 EVAR procedures for AAA. Of these, 216 (54%) were performed electively, and 181 (46%) were performed emergently. The overall rate of EVAR per 100 patient years was 0.27 (95%CI 0.21-0.34) for HD, 0.23 (95%CI 0.09-0.37) for HHD, 0.17 (95%CI 0.10-0.24) for PD, and 0.11 (95%CI 0.05-0.16) for KT.

30-day mortality was highest in the HD cohort at 5.2% (95%CI 2.4-8.1%), and lowest in the KT cohort at 1.3% (95%CI -1.2-3.9%). 12-month mortality was highest in the PD cohort at 29.8% (95%CI 17.9-41.7%), and lowest in the HHD group at 8.6% (95%CI -0.7-17.8%). EVAR was associated with a 12-month mortality of 18.1% (95%CI 12.9-23.2%) when conducted in the elective setting, compared to 29.2% (95%CI 22.5-35.9%) when undertaken emergently.

Rates of infective complications (as a composite of pneumonia, sepsis, and surgical site infection) ranged from 11.4% (95%CI 0.9-22.0%) for HHD, to 18.4% (95%CI 9.7-27.1%) for KT. Rates of vascular complications (as a composite of myocardial infarction and stroke) were most common in PD at 12.3% (95%CI 3.8-20.8%), and least common for HHD at 2.9% (95%CI -2.7-8.4%). Revascularisation for acute limb ischaemia was undertaken in 2.2% (95%CI 0.3-4.1%) for HD and 2.5% (95%CI -1.3-8.3%) for PD patients within 12 months of the index EVAR procedure; no patients from the HHD or KT cohorts received intervention for acute limb ischaemia.

Conclusions:

Rates of endovascular AAA repair were stable over the 16-year period, with patients receiving HD being the most likely cohort to receive this intervention. Infective and vascular complications were common across all modalities of KRT. EVAR performed in patients receiving KRT is associated with high rates of both 30-day and 12-month mortality. This should be taken into consideration when balancing the risk of rupture against the risk of perioperative complications in the elective setting, and during discussions regarding consent for proposed endovascular AAA repair procedures.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.