Endoluminal repair of abdominal aortic aneurysm causes more perioperative renal dysfunction than open repair

Background: In this prospective case–control study the aim was to compare perioperative renal function in well matched patients undergoing open repair (OR) (group 1) or endoluminal repair (ER) (group 2) of an abdominal aortic aneurysm (AAA) and preoperative renal function in other patients undergoing ER (group 3) with function 1–3 years after surgery.Group 1 Group 2 Group 3 Preop. Postop. P Preop. Postop. P Preop. Postop. PSerum creatinine (µmol l −1 ) 122 (82–210) 161 (90–260) <0·008 130 (81–200) 181 (80–341) <0·01 124 (68–256) 146 (68–491) n.s. GFR (ml min −1 ) 52 (30–110) 47 (23–108) <0·01 51 (29–84) 39 (8–97) † <0·008 49 (20–90) 43 (0–114) n.s. MPTTI (s) * 190 270 <0·02 172 267 ‡ <0·002 195 210 n.s.Values are median (range). * Normal <240 s. n.s., Not significant. † P <0·003 ‡ P <0·01 versus group 1 postop.Methods: Of 73 patients undergoing AAA repair, 45 were recruited to the study as follows: 14 patients (median age 77 years, 12 men) to group 1, 14 patients (median age 76 years, 11 men) to group 2 and 17 patients (median age 76 years, 14 men) to group 3. Serum creatinine, creatinine clearance and/or glomerular filtration rate (GFR) were measured coupled with 99m Tc‐radiolabelled mercaptoacetyltriglycine (MAG3) renal studies. From the MAG3 renal scans, perfusion, split renal function, mean parenchymal transit time (MPTTI) and outflow pattern were assessed. Groups 1 and 2 underwent scintigraphic evaluation before, and 8 days after operation. Group 3 was assessed before operation and 1–3 years later. Results: Fifteen of 31 patients undergoing ER had preoperative renal dysfunction (GFR less than 50 ml min −1 ) compared with two of 14 who had OR. Ten patients from groups 2 and 3 developed severe renal dysfunction. Of these, two died, one required haemodialysis (graft deployed over the renals), two were dialysis‐free but developed worsening renal function and five regained their previous renal function. In four patients who had ER, differential function improved, in one with retroperitoneal fibrosis it deteriorated and in nine it was unchanged. See Table below. Conclusion: ER is associated with a greater degree of perioperative renal dysfunction than OR. In the absence of technical problems with endograft deployment, renal function in ER in the long term is not adversely affected. © 2000 British Journal of Surgery Society Ltd