Perioperative renal function following endovascular repair of abdominal aortic aneurysm with suprarenal and infrarenal stents

Abstract

BACKGROUND: Endovascular repair (EVR) of abdominal aortic aneurysm (AAA) is feasible for selected patients. Placing an uncovered stent across the origins of the renal arteries may improve fixation and seal of the proximal end of the stent-graft. However, this has potential for problems (e.g. renal artery stenosis or microembolization). This study aimed to evaluate the short-term effect of a suprarenal stent on the function of the individual kidney. METHODS: In 30 patients undergoing EVR for AAA, renal function was assessed before and after operation by 99mTc-radiolabelled diethylenetriamine penta-acetate radionuclide renography and daily measurement of serum creatinine levels. Eleven patients had infrarenal stent-grafts using an aorta uni-iliac system (group 1); 19 patients had the device with an uncovered suprarenal stent (modified Gianturco Z stent), ten of which were aorta uni-iliac and nine bifurcated systems (group 2). Individual kidney function was expressed as the whole kidney transit time (WKTT). In addition, glomerular filtration rate (GFR) was measured from serial blood samples following renography. RESULTS: [Table: see text] CONCLUSION: No result reached statistical significance. Placing an uncovered stent over the origins of the renal arteries does not appear to impair kidney function in the short term.

Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate

“…Macierewicz et al reported the evaluation of 30 EVAR patients with IR (11) and SR (19) fixation studied by postoperative technetium-labeled diethylene triamine penta-acetic acid (Tc-DTPA) scans and reported that coverage of renal ostia by bare struts did not effect on renal function. 30 Greenberg et al compared 80 open AAA repair patients with 190 patients undergoing EVAR with SR fixation using different definitions of renal dysfunction. 15 EVAR patients had less renal dysfunction prior to hospital discharge than OR patients; subsets of both groups had renal dysfunction prior to discharge and up to 12 months, but they reported that this "stabilized or improved at 12 to 24 months".…”

“…11-20 ; (3) among patients undergoing EVAR, is there a difference in the development of renal function deterioration following infrarenal (IR) vs suprarenal (SR) fixation? [14][15][16][21][22][23][24][25][26][27][28][29][30] ; (4) do surveillance CT scans contribute to renal function deterioration after EVAR? 16 ; (5) what are the risk factors for declining renal function after EVAR and OR?…”

“…8 Nearly all published studies of the effect of EVAR on renal function are limited by short follow-up, lack of open control groups, variable definitions of postoperative renal dysfunction, use of serum creatinine level (SCr) instead of creatinine clearance (CrCl) or glomerular filtration rates (GFR) as a measure of renal function, and a multitude of other confounding variables. Some authors have reported no long-term effect of EVAR on renal function 15,17,21,30 while others have found a significant decline in renal function over time. 3,14,16,22,24,25,29 A recent meta-analysis reported no difference in renal function after EVAR compared with open repair, 35 but most studies were short-term and the definitions of renal function decline were highly variable.…”

Abdominal aortic aneurysm and renal artery stenosis: renal function and blood pressure before and after endovascular treatment

“…Renal function and perfusion remain unaffected in suprarenal placement of stent-grafts. [7][8][9] In our study there were two patients with AAA and unilateral RAS and one patient with AAA and solitary-functioning kidney with RAS.…”

“…So far the presence of the suprarenal stent does not appear to impair kidney function. 2,8 Complications of the endovascular repair of AAA include graft migration and endoleak. Probably improved graft design will secure longterm durability of this procedure.…”