This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial. BJS 2013; 100: 1465-1470.

Published: 4th September 2013

Authors: J. L. de Bruin, M. G. Vervloet, M. G. Buimer, A. F. Baas, M. Prinssen, J. D. Blankensteijn et al.

Background

Deterioration of renal function after major vascular surgery is an important complication, and may vary between patients undergoing endovascular (EVAR) or open surgical (OR) repair of an abdominal aortic aneurysm (AAA). The objective was to determine the impact of OR and EVAR on renal function after 5 years.

Method

This was a post hoc analysis of data collected prospectively from the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. Five years after surgery, creatinine levels were available for 189 patients (94 after OR and 95 after EVAR). The severity of renal disease was staged using the chronic kidney disease classification of the US National Kidney Foundation clinical guidelines.

Results

Using the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation, the estimated glomerular filtration rate (eGFR) for the entire group declined over time, with a mean(s.d.) preoperative value of 80·0(7·6) ml per min per 1·73 m² compared with 75·7(9·7) ml per min per 1·73 m² after 5 years (mean difference 4·2 (95 per cent confidence interval 3·2 to 5·3) ml per min per 1·73 m²; P < 0·001). Five years after surgery, the mean eGFR (CKD‐EPI equation) was not significantly different between the OR and EVAR groups: 76·3(9·3) versus 75·1(10·0) ml per min per 1·73 m² (mean difference 1·2 (−1·6 to 3·9) ml per min per 1·73 m²; P = 0·410).

Conclusion

Renal function 5 years after OR and EVAR for AAA was similar. Neither surgical procedure accelerated the loss of renal function. Registration number: NCT00421330 (http://www.clinicaltrials.gov).

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