Acute Kidney Injury is Associated with Increased Mortality following Thoracic Endovascular Aortic Repair

Background Acute kidney injury (AKI) is common following endovascular procedures and has been independently associated with increased hospital length of stay, mortality, and, in patients with severe chronic kidney disease, accelerated progression to end-stage renal disease requiring dialysis. Prior studies have often focused on peripheral angiograms and infrarenal endovascular aortic repair, with limited contemporary multicenter studies focused on the outcomes of renal function following thoracic endovascular aortic repair (TEVAR). Methods We analyzed the Society for Vascular Surgery –Vascular Quality Initiative TEVAR registry including patients from 2013 to 2025. Patients were stratified based on incidence of AKI in the postoperative period, defined as an increase in serum creatinine of either >0.3 mg/dL or 50% from preoperative baseline. Patients who were dialysis-dependent at the time of TEVAR were excluded from this study. Patient demographics and perioperative variables were compared between the 2 cohorts utilizing univariate analysis. The primary outcome of this study was 30-day mortality among patients undergoing TEVAR stratified by development of AKI. Secondary outcomes included hospital and intensive care unit length of stay, incidence of aortic-related reinterventions, and new dialysis requirement on hospital discharge. A logistic regression was subsequently performed to develop a risk prediction model utilizing AKI as a binary end point, with 70% of the dataset used for training and 30% for testing. Results A total of 26,702 patients who underwent TEVAR were included, of which 3,347 developed postoperative AKI (13%). A higher proportion of patients with AKI were male (65.8% vs. 62.2%, P < 0.0001), had higher preoperative creatinine (1.46 mg/dL vs. 0.99 mg/dL, P < 0.0001), and were more frequently diabetic (17.8% vs. 15.6%, P = 0.0011). TEVAR in patients who developed AKI was more frequently performed emergently (35.2% vs. 14.7%) and for the indication of acute dissection (36.4% vs. 25.7%, both P < 0.0001). The development of postoperative AKI was associated with significantly higher 30-day mortality (21.3% vs. 4.7%) and length of stay (18.3 d vs. 3.6 d, both P < 0.0001). For patients presenting with acute dissection, AKI development was associated with more distal extent of dissection, decreased true lumen perfusion, and postoperative branch patency of all visceral vessels (all P < 0.0001). Conclusion AKI following TEVAR is associated with substantially increased 30-day mortality and is strongly associated with impaired baseline renal function, existing diabetes mellitus, urgent procedures, and aortic dissection.