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Renal risk during EVAR — FRCA Final MCQ

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ModerateCardiothoracic and Vascular AnaesthesiaRenal risk during EVARFRCA Final

A 72-year-old man with chronic kidney disease is scheduled for endovascular aneurysm repair. He has eGFR 28 ml/min/1.73 m2, diabetes and mild heart failure. The radiology team expects substantial iodinated contrast use. What is the most appropriate management?

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Correct answer: D — Optimise hydration and minimise contrast exposure with renal-protective planning

Chronic kidney disease increases the risk of contrast-associated acute kidney injury, so planning should include renal risk assessment, avoidance of nephrotoxins, appropriate hydration and contrast minimisation. Forced diuresis can worsen hypovolaemia. Heart failure requires careful fluid titration rather than fluid omission. EVAR may be less invasive than open surgery but still carries renal and haemodynamic risks.

Reference: NICE acute kidney injury guidance; Vascular Anaesthesia Society EVAR guidance