A Dynamic Approach to Assessing and Predicting AKI Risk in Patients with Aortoiliac Occlusive Disease Undergoing Aorto-Bifemoral Bypass

Background/Objectives: We aim to identify the postoperative acute kidney injury (AKI) risk factors and the predictors of severe AKI derived from routine perioperative elements in patients with aortoiliac occlusive disease who underwent aorto-bifemoral bypass as arterial revascularization. This involves a dynamic assessment throughout the perioperative period. Methods: Preoperative, intraoperative, early postoperative and day-one-after-surgery data were retrospectively reviewed in consecutive patients who underwent elective aorto-bifemoral bypass for aortoiliac occlusive disease classified as TASC II D at the “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases in Bucharest, Romania, between 2017 and 2023. Results: Preoperative clearance of creatinine (OR 1.037, CI95%: 1.009–1.066), the duration of the surgery (OR 1.435, CI 95%: 1.100–1.873), and the change between the day-one-after-surgery and preoperative systemic inflammatory response index (DeltaSIRI_1_preop) (OR 1.080, CI 95%: 1.012–1.152) were identified as independent risk factors for postoperative AKI in patients undergoing aorto-bifemoral revascularization for aortoiliac occlusive disease. The most severe form of AKI was strongly predicted by the number of packed red blood cells transfused (AUC 0.924, p = 0.001), the patient’s age (AUC 0.895, p = 0.001), and the duration of the surgery (AUC 0.895, p = 0.001). Furthermore, various routine and cost-effective variables related to the preoperative period, the early postoperative period, and the first day after surgery also demonstrated significant predictive value. Conclusions: We conducted a dynamic perioperative assessment of AKI associated with major vascular surgery. This aims to equip clinicians with a practical and cost-effective tool for evaluating AKI, thereby facilitating a more individualized approach to the diagnosis of this complication.