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Re: Contrast-induced nephropathy and Endovascular Aortic Aneurysm Repairs
- Michael G Irwin, Gordon Wong (22 November 2007)
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Contrast-induced nephropathy and Endovascular Aortic Aneurysm Repairs
- Matthew D Wiles, Mark M. Brown (6 November 2007)
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Gadolinium Induced Neuropathy
- John George George Cherian (5 October 2007)
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Michael G Irwin , Gordon Wong
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Dear Dr Wiles & Dr Brown Thank you for your 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 (1). This data demonstrated distinctly the lower incidence of systemic complications (especially cardiac and pulmonary) with the use of locoregional anesthesia compared to general anesthesia with high-risk patients particularly benefiting from locoregional anesthesia. High-risk patients with LA also benefited in terms of overall complications (p=0.0017) and cardiac complications (p=0.0281) compared to GA. In regard to renal complications specifically, there was a clear 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 apologise for not clarifying the difference between LA and RA in the context of this reference. Sincerely Michael Irwin Gordon Wong 1. Risk-Adapted Outcome After Endovascular Aortic Aneurysm Repair: Analysis of Anesthesia Types Based on EUROSTAR Data. Ruppert V, Leurs LJ, Rieger J, Steckmeier B, Buth J, Umscheid T. Journal of Endovascular Therapy 2007; 14: 12-22 Conflict of Interest:None declared |
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Matthew D Wiles , Mark M. Brown
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Dear Sir, We read with interest the review paper regarding 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 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 postoperatively) in patients having an EVAR with general, regional or local anaesthesia. In addition, EVARs performed under local anaesthesia accounted for only 6% of total case numbers and the database does not provide any data about conversions from local anaesthesia to either regional or general anaesthesia. Ruptured aortic aneurysms may now be repaired using an endovascular technique (REVAR), which was first described at our institution.[3] The incidence of renal complications in this population is high when compared to a traditional open technique, 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 minimise the nephrotoxic effects of the contrast media. References [1] Wong GT, Irwin MG. Contrast-induced nephropathy. Br J Anaesth. 2007 Oct;99(4):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 Jul;44(1):16-21; discussion [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 Nov;32(5):506-13; discussion 14-5. Conflict of Interest:None declared |
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John George George Cherian Fellow - Malaysian Journal of Medical Laboratory Sciences
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Sirs, In addition to the information adeptly stated by Wong and his team, it is noteworthy that Gadolinium-based imaging agents, that are used to make magnetic resonance imaging or MRI scans more discerning, have been reported to have induced nephrogenic systemic fibrosis, or NSF. Patients with compromised kidney and liver function are at risk for the potentially fatal skin disease nephrogenic systemic fibrosis. There is no effective treatment. John George George Cherian - Fellow, Malaysian Institute of Medical Laboratory Sciences Corresspondence: 4 Lrg 4/48 F, 46050 , PJ, Selangor, Malaysia The new warning would alert patients with severe kidney insufficiency, as well as those with liver transplants or chronic liver disease experiencing kidney insufficiency, that they are at risk for NSF Conflict of Interest:None declared |
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