Comparison of Hybrid Vascular Grafts and Standard Grafts in Terms of Kidney Injury for the Treatment of Thoraco-Abdominal Aortic Aneurysm

World J Surg. 2020 Jun;44(6):2010-2019. doi: 10.1007/s00268-020-05415-3.

Abstract

Background: We present a comparison of renal function outcomes during HTAR with the use of a new hybrid vascular graft (GHVG) or standard graft.

Methods: It is a multicenter, retrospective, observational study. Between January 2015 and March 2019, 36 patients were treated with HTAR. We compared HTAR performed with the use of the GHVG and with the use of standard bypass graft. Primary outcome measures were hospital mortality, acute kidney injury (AKI) at 30 days and GHVG patency.

Results: Mean GHVG ischemia time was significantly lower for both renal arteries (right: GHVG, 4 ± 2 vs. standard graft, 15 ± 7 min; 95% CI 2.23-6.69, P < 0.001; left: GHVG, 3 ± 2 vs. standard graft, 13 ± 7 min; 95% CI 2.44-5.03, P < 0.001). Hospital mortality was 17% (6/36); while mortality did not differ between the two groups, postoperative acute kidney injury rate was 30.5% (11/36 patients) and was more common in the standard graft group (7% vs. 29%; OR 3.2, P = 0.074). Estimated primary patency was 92% ± 2 (95% CI 79.5-97%) at 36 months and was not different between the two groups (GHVG 94% ± 6 vs. standard graft 91% ± 6; log-rank χ2 = 0.260, P = 0.610).

Conclusions: In our experience of HTAR, ischemia time was significantly shorter and postoperative AKI occurrence was lower with GHVG if compared to standard graft bypass, with satisfactory midterm patency rate comparable to that of standard graft bypass.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Thoracic / surgery*
  • Blood Vessel Prosthesis / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Female
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / surgery
  • Male
  • Retrospective Studies
  • Treatment Outcome
  • Vascular Grafting / adverse effects*
  • Vascular Patency
  • Warm Ischemia