Acute kidney injury after surgical treatment of failed endovascular aneurysm repair

Background: This study aims to report the incidence of acute kidney injury following surgical reconstruction after a failed endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms. Methods: This retrospective study included 44 patients (39 males, 5 females; mean age: 70 +/- 11.3 years; range, 35 to 84 years) who underwent emergency or elective surgical reconstruction after failed EVAR between February 2015 and January 2019. Patients were divided into two groups: acute kidney injury group and no acute kidney injury group. The primary end-point of the study was to evaluate the development of acute kidney injury following surgery. The secondary end-points included the 30-day and one-year mortality rates. Results: Surgical reconstruction of the abdominal aorta was performed electively in 29 (65.9%) patients and urgently in 15 (34.1%) patients. Acute kidney injury occurred in 12 (27.3%) patients. The interval from endovascular aneurysm repair to surgical reconstruction was statistically significantly higher in the no acute kidney injury group than in the acute kidney injury group (24.6 +/- 11.5 and 18.1 +/- 13.3 months, respectively; p=0.145). The mean abdominal aortic aneurysm diameter, neck angulation, and neck diameter were statistically significantly higher in the acute kidney injury group than in the no acute kidney injury group (p=0.001, p=0.009, and p<0.001, respectively). No statistically significant difference was observed between the acute kidney injury and no acute kidney injury groups for the overall 30-day mortality (p=0.185) and oneyear mortality (p=0.999). Conclusion: Acute kidney injury is not uncommon after the surgical reconstruction of a failed EVAR. Aneurysm-related anatomical factors may have an impact on the development of postoperative acute kidney injury. Comprehensive surgical planning should be performed for open abdominal aortic surgery after a failed EVAR.