Differences in renal response between endovascular and open repair of abdominal aortic aneurysms

Objectives: to determine the difference in venal and systemic response betw een open and endovascular aneurysm repair. Materials and Methods: toe studied prospectively 22 patients undergoing ope n repair (OR) and 15 patients undergoing endovascular repair (ER). Blood an d urine samples were taken preoperatively (T0) and before clamping of the a orta or femoral artery (T1) and 5 min (T2), 1h (T3), 6h (T4), 24h (Day 1) a nd 48h (Day 2) after declamping. Albumin/ creatinin untie (AC ratio) in uri ne, serum albumin, serum creatinin, serum C-reactive protein and serum lact ate were determined. Results: the urinary AC ratio in ER was significantly lower than in OR (p<0 .001). In both groups the rise in urine albumin/creatinin ratio after decla mping (T2, T3) was significant (p<0.001). C-reactive protein was raised sig nificantly at day 2 and 2 in both groups (p<0.001) with no difference betwe en the groups. Serum lactate values were significantly higher in OR. There was a significant increase in serum lactate 6h after declamping in the ER g roup. Conclusions: after endovascular repair renal damage is less compared to ope n repair. There is a significant systemic reaction to the endovascular repa ir causing mild, shout-lasting damage to the kidney. This systemic response is most probably induced by a combination of ischaemia reperfusion? injury and the surgical trauma of the procedure. Other possible explanations are discussed.