Perioperative and mid-term outcomes of endovascular aortic repair in patients with moderate-to-advanced chronic kidney disease: a retrospective cohort study.

BACKGROUND: Aortic lesions and chronic kidney disease (CKD) frequently coexist, increasing perioperative risks. While endovascular aortic repair (EVAR/TEVAR) offers a less invasive alternative, its safety profile in moderate-to-advanced CKD remains unclear. This study evaluated clinical outcomes and prognostic factors in this high-risk population. METHODS: We conducted a retrospective, age- and sex-matched cohort analysis of 58 patients (29 with CKD, 29 without) undergoing EVAR/TEVAR between 2012 and 2024. Outcomes were compared between groups, with prespecified exploratory subgroup analyses performed within the CKD cohort. RESULTS: Compared with the non-CKD group, the CKD group had a higher prevalence of hypertension, higher preoperative creatinine and B-type natriuretic peptide levels, lower estimated glomerular filtration rate, and lower hemoglobin levels. Perioperative complications were more frequent in the CKD group (41.38% vs. 6.90%; p = 0.006), and postoperative ICU and hospital stays were longer. No 30-day deaths occurred. One-year survival was 96.55% in the CKD group and 100% in the non-CKD group (p = 1.000). Only one death was recorded during follow-up, precluding reliable multivariable survival modeling. In the conventional logistic model, CKD was associated with perioperative complications (OR = 9.03, 95% CI 1.63-50.01; p = 0.012); in the Firth sensitivity analysis, the estimate was attenuated (OR = 4.40, 95% CI 0.97-19.92; p = 0.054). CONCLUSION: EVAR/TEVAR may be considered for carefully selected patients with moderate-to-advanced CKD, but these patients experienced a greater perioperative complication burden and longer hospitalization. The survival data were too sparse to support firm comparative conclusions. Individualized risk assessment, perioperative kidney protection, and proactive complication management remain essential.