Acute Kidney Failure Following Endovascular Aneurysm Repair: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND Endovascular aneurysm repair (EVAR) is a minimally invasive alternative to open surgical repair (OSR) for abdominal aortic aneurysms (AAA), offering reduced perioperative morbidity and mortality. However, acute kidney injury (AKI) remains a worrisome complication, driven by multifactorial mechanisms. This systematic review with meta-analysis aims to determine the incidence and risk factors for AKI in patients undergoing EVAR. MATERIALS AND METHODS Three electronic databases, MEDLINE, Cochrane, and Web of Science, were used to search for studies assessing the occurrence of AKI in the postoperative setting of patients undergoing EVAR. The incidence of AKI was pooled by random-effects meta-analysis, with sources of heterogeneity explored by meta-regression. The National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool was used to assess the quality of studies. RESULTS Thirty-eight studies were included, with 80,622 participants. Three were registries with 71,624 patients, while the remaining 9,145 were from prospective and retrospective cohort studies. The meta-analytical incidence of AKI after EVAR was 11.6% [95% CI 9.5%-13.8%], but severe heterogeneity was observed (I^2 = 94.1%). The incidence varied widely between studies, ranging from 2% to 51%, with definitions varying according to different criteria, with KDIGO being the most commonly used. CONCLUSION AKI incidence is low but a clinically relevant complication after EVAR in high-risk patients with multiple modifiable risk factors. Standardized risk assessment models and nephroprotective strategies are needed to optimize patient outcomes. Future research should focus on prospective studies evaluating targeted interventions to reduce AKI incidence and improve renal function preservation.