Selection criterion for endovascular aortic repair in those with chronic kidney disease
Endovascular aortic repair (EVAR) is the preferred method of repair for abdominal aortic aneurysms (AAAs). However, patients with advanced chronic kidney disease (CKD) are a high-risk group, and it is unknown which patients with CKD benefit from EVAR vs continued surveillance. The purpose of this st...
Gespeichert in:
| Veröffentlicht in: | Journal of vascular surgery 2023-06, Vol.77 (6), p.1625-1635.e3 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1635.e3 |
|---|---|
| container_issue | 6 |
| container_start_page | 1625 |
| container_title | Journal of vascular surgery |
| container_volume | 77 |
| creator | Khoury, Mitri K. Thornton, Micah A. Weaver, Fred A. Ramanan, Bala Tsai, Shirling Timaran, Carlos H. Modrall, J. Gregory |
| description | Endovascular aortic repair (EVAR) is the preferred method of repair for abdominal aortic aneurysms (AAAs). However, patients with advanced chronic kidney disease (CKD) are a high-risk group, and it is unknown which patients with CKD benefit from EVAR vs continued surveillance. The purpose of this study was to identify which patients with advanced CKD may benefit from EVAR.
The Vascular Quality Initiative Database was utilized to identify elective EVARs for AAAs. Patients were excluded if they underwent urgent or emergent repairs. CKD stages were categorized based on preoperative estimated glomular filtration rate (eGFR) and dialysis status. Predicted 1-year mortality of untreated AAAs was calculated by modifying a validated comorbidity score that predicts 1-year mortality (Gagne Index) without repair. The primary outcome was actual 1-year mortality, which was compared with the predicted 1-year mortality without repair.
A total of 34,926 patient met study criteria. There were differences in Gagne Indices among the varying classes of CKD. Patients with CKD 4 and CKD 5 had the highest 1-year mortality rates, followed by CKD 3b, which was significantly higher than those with CKD 1 and CKD 2. Patients with CKD 4 had no differences between actual 1-year mortality with EVAR and predicted 1-year survival without EVAR across all AAA sizes. Those with CKD 5 had worse actual 1-year survival with EVAR than predicted 1-year survival without EVAR for AAAs |
| doi_str_mv | 10.1016/j.jvs.2023.01.185 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2773121841</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0741521423002689</els_id><sourcerecordid>2773121841</sourcerecordid><originalsourceid>FETCH-LOGICAL-c353t-852a2e8f1718f112684b50f867b2e292e7d15820c7800376c386a57a0832eb433</originalsourceid><addsrcrecordid>eNp9kE9LAzEQxYMotlY_gBfJ0cuumWR3k-JJiv-g4EHFY0izszR1u6nJttJvb0qrRy8zA_PmMe9HyCWwHBhUN4t8sYk5Z1zkDHJQ5REZAhvLrFJsfEyGTBaQlRyKATmLccEYQKnkKRmISgqQZTUkH6_You2d76gNrsewmxofKHa135ho160J1PjQO0sDrowL1HW0n_uI9Nv1c2rnwXdp-enqDre0dhFNxHNy0pg24sWhj8j7w_3b5Cmbvjw-T-6mmRWl6DNVcsNRNSAhFeCVKmYla1QlZxz5mKOs08ucWakYE7KyQlWmlIYpwXFWCDEi13vfVfBfa4y9XrposW1Nh34dNZcpKQdVQJLCXmqDjzFgo1fBLU3YamB6x1MvdOKpdzw1A514ppurg_16tsT67-IXYBLc7gWYQm4cBh2tw85i7ULiqmvv_rH_AbKphWk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2773121841</pqid></control><display><type>article</type><title>Selection criterion for endovascular aortic repair in those with chronic kidney disease</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Khoury, Mitri K. ; Thornton, Micah A. ; Weaver, Fred A. ; Ramanan, Bala ; Tsai, Shirling ; Timaran, Carlos H. ; Modrall, J. Gregory</creator><creatorcontrib>Khoury, Mitri K. ; Thornton, Micah A. ; Weaver, Fred A. ; Ramanan, Bala ; Tsai, Shirling ; Timaran, Carlos H. ; Modrall, J. Gregory</creatorcontrib><description>Endovascular aortic repair (EVAR) is the preferred method of repair for abdominal aortic aneurysms (AAAs). However, patients with advanced chronic kidney disease (CKD) are a high-risk group, and it is unknown which patients with CKD benefit from EVAR vs continued surveillance. The purpose of this study was to identify which patients with advanced CKD may benefit from EVAR.
The Vascular Quality Initiative Database was utilized to identify elective EVARs for AAAs. Patients were excluded if they underwent urgent or emergent repairs. CKD stages were categorized based on preoperative estimated glomular filtration rate (eGFR) and dialysis status. Predicted 1-year mortality of untreated AAAs was calculated by modifying a validated comorbidity score that predicts 1-year mortality (Gagne Index) without repair. The primary outcome was actual 1-year mortality, which was compared with the predicted 1-year mortality without repair.
A total of 34,926 patient met study criteria. There were differences in Gagne Indices among the varying classes of CKD. Patients with CKD 4 and CKD 5 had the highest 1-year mortality rates, followed by CKD 3b, which was significantly higher than those with CKD 1 and CKD 2. Patients with CKD 4 had no differences between actual 1-year mortality with EVAR and predicted 1-year survival without EVAR across all AAA sizes. Those with CKD 5 had worse actual 1-year survival with EVAR than predicted 1-year survival without EVAR for AAAs <5.5 cm. Patients with CKD 5 only experienced an actual mortality benefit with EVAR compared with predicted 1-year mortality without EVAR for AAAs ≥7.0 cm.
The current data suggest that patients with CKD 3b, 4, and 5 represent a high-risk group who may not benefit from elective EVAR utilizing traditional size criteria. Patients with CKD 4 and 5 with AAAs <5.5 cm do not benefit from elective EVAR. In patients with CKD 5, elective EVAR may need to be reserved for AAAs ≥7.0 cm unless there are other concerning anatomic characteristics.
[Display omitted]</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2023.01.185</identifier><identifier>PMID: 36731756</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - surgery ; Chronic kidney disease ; Comorbidity ; Endovascular ; Endovascular Aneurysm Repair ; Humans ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - surgery</subject><ispartof>Journal of vascular surgery, 2023-06, Vol.77 (6), p.1625-1635.e3</ispartof><rights>2023 Society for Vascular Surgery</rights><rights>Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-852a2e8f1718f112684b50f867b2e292e7d15820c7800376c386a57a0832eb433</citedby><cites>FETCH-LOGICAL-c353t-852a2e8f1718f112684b50f867b2e292e7d15820c7800376c386a57a0832eb433</cites><orcidid>0000-0003-3174-2472</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521423002689$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36731756$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khoury, Mitri K.</creatorcontrib><creatorcontrib>Thornton, Micah A.</creatorcontrib><creatorcontrib>Weaver, Fred A.</creatorcontrib><creatorcontrib>Ramanan, Bala</creatorcontrib><creatorcontrib>Tsai, Shirling</creatorcontrib><creatorcontrib>Timaran, Carlos H.</creatorcontrib><creatorcontrib>Modrall, J. Gregory</creatorcontrib><title>Selection criterion for endovascular aortic repair in those with chronic kidney disease</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Endovascular aortic repair (EVAR) is the preferred method of repair for abdominal aortic aneurysms (AAAs). However, patients with advanced chronic kidney disease (CKD) are a high-risk group, and it is unknown which patients with CKD benefit from EVAR vs continued surveillance. The purpose of this study was to identify which patients with advanced CKD may benefit from EVAR.
The Vascular Quality Initiative Database was utilized to identify elective EVARs for AAAs. Patients were excluded if they underwent urgent or emergent repairs. CKD stages were categorized based on preoperative estimated glomular filtration rate (eGFR) and dialysis status. Predicted 1-year mortality of untreated AAAs was calculated by modifying a validated comorbidity score that predicts 1-year mortality (Gagne Index) without repair. The primary outcome was actual 1-year mortality, which was compared with the predicted 1-year mortality without repair.
A total of 34,926 patient met study criteria. There were differences in Gagne Indices among the varying classes of CKD. Patients with CKD 4 and CKD 5 had the highest 1-year mortality rates, followed by CKD 3b, which was significantly higher than those with CKD 1 and CKD 2. Patients with CKD 4 had no differences between actual 1-year mortality with EVAR and predicted 1-year survival without EVAR across all AAA sizes. Those with CKD 5 had worse actual 1-year survival with EVAR than predicted 1-year survival without EVAR for AAAs <5.5 cm. Patients with CKD 5 only experienced an actual mortality benefit with EVAR compared with predicted 1-year mortality without EVAR for AAAs ≥7.0 cm.
The current data suggest that patients with CKD 3b, 4, and 5 represent a high-risk group who may not benefit from elective EVAR utilizing traditional size criteria. Patients with CKD 4 and 5 with AAAs <5.5 cm do not benefit from elective EVAR. In patients with CKD 5, elective EVAR may need to be reserved for AAAs ≥7.0 cm unless there are other concerning anatomic characteristics.
[Display omitted]</description><subject>Aneurysm</subject><subject>Aorta</subject><subject>Aortic Aneurysm, Abdominal - diagnostic imaging</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Chronic kidney disease</subject><subject>Comorbidity</subject><subject>Endovascular</subject><subject>Endovascular Aneurysm Repair</subject><subject>Humans</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Renal Insufficiency, Chronic - surgery</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LAzEQxYMotlY_gBfJ0cuumWR3k-JJiv-g4EHFY0izszR1u6nJttJvb0qrRy8zA_PmMe9HyCWwHBhUN4t8sYk5Z1zkDHJQ5REZAhvLrFJsfEyGTBaQlRyKATmLccEYQKnkKRmISgqQZTUkH6_You2d76gNrsewmxofKHa135ho160J1PjQO0sDrowL1HW0n_uI9Nv1c2rnwXdp-enqDre0dhFNxHNy0pg24sWhj8j7w_3b5Cmbvjw-T-6mmRWl6DNVcsNRNSAhFeCVKmYla1QlZxz5mKOs08ucWakYE7KyQlWmlIYpwXFWCDEi13vfVfBfa4y9XrposW1Nh34dNZcpKQdVQJLCXmqDjzFgo1fBLU3YamB6x1MvdOKpdzw1A514ppurg_16tsT67-IXYBLc7gWYQm4cBh2tw85i7ULiqmvv_rH_AbKphWk</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Khoury, Mitri K.</creator><creator>Thornton, Micah A.</creator><creator>Weaver, Fred A.</creator><creator>Ramanan, Bala</creator><creator>Tsai, Shirling</creator><creator>Timaran, Carlos H.</creator><creator>Modrall, J. Gregory</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3174-2472</orcidid></search><sort><creationdate>202306</creationdate><title>Selection criterion for endovascular aortic repair in those with chronic kidney disease</title><author>Khoury, Mitri K. ; Thornton, Micah A. ; Weaver, Fred A. ; Ramanan, Bala ; Tsai, Shirling ; Timaran, Carlos H. ; Modrall, J. Gregory</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-852a2e8f1718f112684b50f867b2e292e7d15820c7800376c386a57a0832eb433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aneurysm</topic><topic>Aorta</topic><topic>Aortic Aneurysm, Abdominal - diagnostic imaging</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Chronic kidney disease</topic><topic>Comorbidity</topic><topic>Endovascular</topic><topic>Endovascular Aneurysm Repair</topic><topic>Humans</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Renal Insufficiency, Chronic - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khoury, Mitri K.</creatorcontrib><creatorcontrib>Thornton, Micah A.</creatorcontrib><creatorcontrib>Weaver, Fred A.</creatorcontrib><creatorcontrib>Ramanan, Bala</creatorcontrib><creatorcontrib>Tsai, Shirling</creatorcontrib><creatorcontrib>Timaran, Carlos H.</creatorcontrib><creatorcontrib>Modrall, J. Gregory</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khoury, Mitri K.</au><au>Thornton, Micah A.</au><au>Weaver, Fred A.</au><au>Ramanan, Bala</au><au>Tsai, Shirling</au><au>Timaran, Carlos H.</au><au>Modrall, J. Gregory</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Selection criterion for endovascular aortic repair in those with chronic kidney disease</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2023-06</date><risdate>2023</risdate><volume>77</volume><issue>6</issue><spage>1625</spage><epage>1635.e3</epage><pages>1625-1635.e3</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Endovascular aortic repair (EVAR) is the preferred method of repair for abdominal aortic aneurysms (AAAs). However, patients with advanced chronic kidney disease (CKD) are a high-risk group, and it is unknown which patients with CKD benefit from EVAR vs continued surveillance. The purpose of this study was to identify which patients with advanced CKD may benefit from EVAR.
The Vascular Quality Initiative Database was utilized to identify elective EVARs for AAAs. Patients were excluded if they underwent urgent or emergent repairs. CKD stages were categorized based on preoperative estimated glomular filtration rate (eGFR) and dialysis status. Predicted 1-year mortality of untreated AAAs was calculated by modifying a validated comorbidity score that predicts 1-year mortality (Gagne Index) without repair. The primary outcome was actual 1-year mortality, which was compared with the predicted 1-year mortality without repair.
A total of 34,926 patient met study criteria. There were differences in Gagne Indices among the varying classes of CKD. Patients with CKD 4 and CKD 5 had the highest 1-year mortality rates, followed by CKD 3b, which was significantly higher than those with CKD 1 and CKD 2. Patients with CKD 4 had no differences between actual 1-year mortality with EVAR and predicted 1-year survival without EVAR across all AAA sizes. Those with CKD 5 had worse actual 1-year survival with EVAR than predicted 1-year survival without EVAR for AAAs <5.5 cm. Patients with CKD 5 only experienced an actual mortality benefit with EVAR compared with predicted 1-year mortality without EVAR for AAAs ≥7.0 cm.
The current data suggest that patients with CKD 3b, 4, and 5 represent a high-risk group who may not benefit from elective EVAR utilizing traditional size criteria. Patients with CKD 4 and 5 with AAAs <5.5 cm do not benefit from elective EVAR. In patients with CKD 5, elective EVAR may need to be reserved for AAAs ≥7.0 cm unless there are other concerning anatomic characteristics.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36731756</pmid><doi>10.1016/j.jvs.2023.01.185</doi><orcidid>https://orcid.org/0000-0003-3174-2472</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0741-5214 |
| ispartof | Journal of vascular surgery, 2023-06, Vol.77 (6), p.1625-1635.e3 |
| issn | 0741-5214 1097-6809 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2773121841 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aneurysm Aorta Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - surgery Chronic kidney disease Comorbidity Endovascular Endovascular Aneurysm Repair Humans Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - surgery |
| title | Selection criterion for endovascular aortic repair in those with chronic kidney disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-13T01%3A23%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Selection%20criterion%20for%20endovascular%20aortic%20repair%20in%20those%20with%20chronic%20kidney%20disease&rft.jtitle=Journal%20of%20vascular%20surgery&rft.au=Khoury,%20Mitri%20K.&rft.date=2023-06&rft.volume=77&rft.issue=6&rft.spage=1625&rft.epage=1635.e3&rft.pages=1625-1635.e3&rft.issn=0741-5214&rft.eissn=1097-6809&rft_id=info:doi/10.1016/j.jvs.2023.01.185&rft_dat=%3Cproquest_cross%3E2773121841%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2773121841&rft_id=info:pmid/36731756&rft_els_id=S0741521423002689&rfr_iscdi=true |