Elif COŞKUN SUNGUR, Levent ALTINAY, Anıl TEKİN, Sıtkı TURAN, Ufuk TÜTÜN

Yeni Başlayan Böbrek Yetmezliğinin Endovasküler Aort Onarımı Yapılan Hastalarda Mortalite Oranlarına Etkisi

Amaç: Aort patolojilerinde özellikle inen torasik ve abdominal aortayı içeren aort diseksiyonlarında visseral organ kan dolaşımı ciddi şekilde bozulur. Bu çalışmada EVAR ve TEVAR uygulanan hastalarda yeni başlayan böbrek fonksiyon bozukluğunun postoperatif mortalite oranlarına etkisini belirlemeyi amaçladık. Yöntemler: Bu retrospektif çalışmaya kliniğimizde EVAR/TEVAR işlemi uygulanan hastalar dahil edildi. Hastalar böbrek fonksiyon bozukluğu varlığına göre iki gruba ayrıldı. Gruplar için ölüm oranları hesaplandı. Bulgular: Kasım 2016 ile Mayıs 2021 arasında EVAR/TEVAR prosedürü uygulanan toplam 60 hasta bu çalışmaya dahil edildi. Grup 1, postoperatif böbrek fonksiyon bozukluğu olmayan 48 (%80) hastayı içermiştir. Grup 2'de postoperatif böbrek fonksiyon bozukluğu olan toplam 12 (%20) hasta vardı. Verilerin ilk analizi, grupların yaş ve cinsiyet değişkenlerinde anlamlı farklılıklar olduğunu ortaya koydu (sırasıyla P=0.038 ve P=0.008). Daha sonra gruplarda yanlılığı önlemek için eğilim skoru eşleştirmesi yapıldı. Eğilim skoru eşleştirmesinden sonra Grup 1'e postoperatif böbrek yetmezliği olmayan 12 (%50) hasta ve Grup 2'ye postoperatif renal disfonksiyonu olan 12 (%50) hasta dahil edildi. Eğilim eşleştirmesinden sonra gruplar arasında önemli farklılıklar yoktu. Ölüm oranı gruplar arasında önemli ölçüde farklıydı. Sonuçlar: EVAR/TEVAR prosedürlerinden sonra böbrek fonksiyonları dikkatle izlenmelidir çünkü böbrek yetmezliği postoperatif mortalite ile yakından ilişkilidir. Düzenli olarak uygulanan EVAR/TEVAR işlemleri sonrası böbrek fonksiyonları ve mortalite ilişkisi konusunda daha geniş hasta sayıları ile daha fazla araştırma yapılması gerektiğini düşünüyoruz.

Anahtar Kelimeler:

endovasküler onarım, böbrek yetmezliği, mortalite

The Effect of Newly Onset Renal Impairment on the Mortality Rates of the Patients Undergoing Endovascular Aortic Repair

Abstract Background: Visceral organ blood circulation is seriously impaired in aortic pathologies especially aortic dissection involving descending thoracic and abdominal aorta. Herein, we aimed to determine the effect of the newly onset renal function impairment on postoperative mortality rates of the patients undergoing EVAR and TEVAR procedures. Methods: Patients who underwent an EVAR / TEVAR procedure in our clinic included in this retrospective study. Patients were divided into two groups according to the presence of renal function impairment. Mortality rates were calculated for the groups. Results: A total of 60 patients who underwent an EVAR/TEVAR procedure between November 2016 and May 2021 included in this study. Group 1 included a number of 48 (80%) patients without postoperative renal dysfunction. Group 2 included a total of 12 (20%) patients with postoperative renal function impairment. The initial analysis of the data revealed significant differences in the age and sex variables of the groups (P=0.038 and P=0.008 respectively). Then propensity score matching was performed to avoid bias in the groups. After propensity score matching Group 1 included 12 (50%) patients without postoperative renal impairment and Group 2 included 12 (50%) patients with postoperative renal dysfunction. There were no significant differences between the groups after propensity matching. Mortality rate was significantly different between the groups which was 1 patient (8.33%) in Group 1 vs 6 (50.00%) patients in Group 2 (P=0.020). Conclusions: Renal functions after EVAR/TEVAR procedures should be carefully monitored because renal impairment is closely related with postoperative mortality. We suggest that more studies with larger patient numbers should be conducted on the relation of renal functions and mortality after regularly performed EVAR/TEVAR procedures.

Keywords:

endovascular aortic repair, renal impairment, mortality,

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