Contrast-induced nephropathy and endovascular aortic aneurysm repairs
Nottingham, UK
* E-mail: matt.wiles{at}nottingham.ac.uk
Editor—We read with interest the review of contrast-induced nephropathy (CIN) by Wong and Irwin.1 The authors should be commended for an excellent article, but we would like to comment upon CIN and endovascular aortic aneurysm repairs (EVARs). The authors suggest that performing an EVAR under local anaesthesia (LA) may be of some benefit in preventing CIN. The Eurostar data from which this conclusion is drawn cannot support this assertion.2 This demonstrated that there was no significant difference between the incidence of renal complications (up to 30 days after operation) in patients having an EVAR with general anaesthesia (GA), regional anaesthesia (RA), or LA. In addition, EVARs performed under LA accounted for only 6% of total case numbers and the database does not provide any data about conversions from LA to either RA or GA.
Ruptured aortic aneurysms may now be repaired using an endovascular technique (REVAR), which was first described at our institution. The incidence of renal complications in this population is high when compared with a traditional open technique,3 and this is most probably due to the additional renal damage induced by CIN. It is our practice to hydrate aggressively these patients from the time of their admission to the emergency department in order to try to minimize the nephrotoxic effects of the contrast media.
Hong Kong
* E-mail: mgirwin{at}hkucc.hku.hk
Editor—We wish to thank Drs Wiles and Brown for their comments regarding our recent review article. We actually meant to imply the potential overall benefits of LA but also inadvertently quoted the wrong reference in relation to the Eurostar data.4 These data demonstrated distinctly the lower incidence of systemic complications (especially cardiac and pulmonary) with the use of LA or RA compared with GA, with high-risk patients particularly benefiting from loco-regional anaesthesia. High-risk patients with LA also benefited in terms of overall complications (P=0.0017) and cardiac complications (P=0.0281) compared with GA. With specific regard to renal complications, there was a benefit of RA over GA, but there was no significant difference between GA and LA. There was, however, a trend towards a reduction and the small number of patients receiving LA would have led to a low statistical power in this regard. We apologize for not clarifying the difference between LA and RA in the context of this reference.
References
1 Wong GT, Irwin MG. Contrast-induced nephropathy. Br J Anaesth (2007) 99:474–83.
2 Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg (2006) 44:16–21.[CrossRef][Web of Science][Medline]
3 Hinchliffe RJ, Bruijstens L, MacSweeney ST, Braithwaite BD. A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg (2006) 32:506–13.[CrossRef][Web of Science][Medline]
4 Ruppert V, Leurs LJ, Rieger J, Steckmeier B, Buth J, Umscheid T. Risk-adapted outcome after endovascular aortic aneurysm repair: analysis of anesthesia types based on EUROSTAR data. J Endovasc Ther (2007) 14:12–22.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||