ارزيابي عوامل خطرساز بروز نارسايي حاد كليه در جراحي آنوريسم آئورت شكمي‌

Evaluation of riskfactors for acute renal failure in surgery of abdominal aortic aneurysm

Background: Acute renal failure following aortic aneurysm surgery is a common complication and is associated with high mortality and morbidity rate. Also, acute renal failure has high mortality rate, irrespective of its cause. Methods: In a retrospective-descriptive study, in order to identify major risk factors for acute renal failure following elective and emergent repair of abdominal aortic aneurysm, hospital records of 70 patients whom were operated by the same surgical technique (transperitoneal approach) in a university hospital in Tehran during the past 7 years were evaluated. The studied variables were major concomitant medical diseases, preoperative renal dysfunction, acute renal failure, renal ischemic time in minutes, intra operative hypotension, contrast radiologic dye use, and conditions related to the nature of aneurysm and its surgery. Results: A number of 53 men and 17 women with average age of 70 (range 37-90 yrs) years were studied. A total of 33% of them had chronic obstructive pulmonary disease. Baseline serum creatinine in 19% of the cases was greater than 1.5 mg/dl. One patient was dialysis-dependent and 53% of the eases had significant ischemic heart disease. The emergency operation was done in 14%>. Rupture of aneurysm and aortic dissection were developed in 17% and 13% of the patients, respectively. The postoperative mortality rate for elective and emergency operation was 20% and 70%, respectively. Significant renal failure was developed in 20% with a mortality rate of 57%. Hemodialysis was done in 4 eases with a 50% mortality rate. In this study, we found significant correlation between postoperative renal failure and emergency operation (P=0.01), rupture of aneurysm (P-0.039) and postoperative mortality rate (P~0.005). There were no significant correlations between other variables. Conclusion: Acute renal failure following surgery of abdominal aortic aneurysm surgery is common. It has significant correlation with emergency surgery and rupture of abdominal aortic aneurysm.