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Taste of Boston
Taste of Boston

International Plenary

IP07 - The impact of perioperative acute kidney injury on early and follow-up mortality of fenestrated/branched endovascular aortic repair in juxta/para-renal and thoracoabdominal aneurysms.

Wednesday, June 10, 2026
2:06 PM - 2:11 PM ET
Location: Hynes CC, Third Level, Room 306
Objectives: To analyze the impact of perioperative acute kidney injury (AKI) after fenestrated/branched endovascular aortic repair (F/B-EVAR) in juxta/para-renal (J/P-AAAs) and thoracoabdominal (TAAAs) aneurysms.

Methods: This was a single-center, retrospective analysis of patients who underwent F/B-EVAR between January 2010 and June 2025. Outcomes were reported according to the Society for Vascular Surgery reporting standards. Specifically, perioperative AKI was defined and staged using the 2012 Kidney Disease Improving Global Outcomes criteria. The incidence of perioperative AKI, its risk-factors and the impact on patient’ survival were assessed as study’s endpoints.

Results: Out of 466 F/B-EVAR cases, there were 256(55%) J/P-AAAs and 210(45%) TAAAs. Fifty-six (12%) patients were managed in urgent setting and 146(31%) had a preoperative chronic renal impairment. There was an intraoperative renal artery loss in 19(4%) cases. The mean iodinated contrast media (ICM) amount was 179 + 97 mL. Eighty-eight (19%) cases of AKI occurred: 70(15%) stage I, 10(2%) stage II and 8(2%) stage III with 6(1%) patients requiring dialysis. Independent determinants of AKI were preoperative chronic renal impairment (OR: 2.5; 95% CI: 1.5-4.3; P: < 0.001), intraoperative renal artery loss (OR: 4.1; 95% CI: 4.5-11.4; P: 0.005), ICM (OR: 1.1; 95% CI: 1.1-1.3; P: 0.02) and urgent setting (OR: 2.3; 95% CI: 1.2-4.8; P: 0.02). The fourth quartile of study’s cohort (last 25% of patients) was a protective factor for AKI (OR: 2.8; 95% CI: 1.4-5.8; P: 0.005). Twenty-eight (6%) patients died within 30-day or during a prolonged/complicated hospitalization. AKI was an independent determinant of hospital mortality (OR: 4.3; 95% CI: 1.7-10.7; P: 0.002). The mean follow-up was 40 + 17 months. Estimated 5-year survival was 60% and it was significantly lower in patients with postoperative AKI than those without AKI (47% vs 64%; Log Rank: P: < 0.001). Estimated 5-year survivals for AKI severity stratification were 52% for stage I, 39% for stage II, and 0% for stage III (Log Rank: P: < 0.001:), respectively. AKI (HR: 1.5; 95% CI: 1.2-2.2; P: 0.009) and stage III (HR: 9.4; 95% CI: 4.1-21.4; P: < 0.001) were confirmed as independent determinants of follow-up mortality at the Cox-regression.

Conclusions: AKI occurred in 19% of patients after F/B-EVAR and impacts on early and follow-up mortality. Preoperative chronic renal impairment, intraoperative renal artery loss, ICM amount and urgent setting were determinants of AKI. Operator’s experience had a protective role for AKI. These factors should be considered during patient selection/management to optimize the outcomes.