Proximal fixation of endovascular aortic device may not be associated with renal function decline after abdominal aortic aneurysm repair

Erben, Young; Li, Y.; Mao, Michael A; Hamid, Osman S.; Franco-Mesa, Camila; Rocha-Franco, Joao A. Da; Stone, William M.; Fowl, Richard J.; Oldenburg, W. Andrew; Farres, Houssam; Meltzer, Andrew J.; Gloviczki, Péter; Martino, Randall R. De; Bower, Thomas C.; Kalra, Manju; Oderich, Gustavo S.; Hakaim, Albert G.

doi:10.1016/j.jvs.2021.05.050

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Similarly, Erben et al (68), using follow-up of 4.8± 3.7 years, found on Kaplan-Meier analysis that CKD patients undergoing SRF were more likely to progress to haemodialysis (P=0.039). Furthermore, the authors found on least square multivariable regression that SRF (Coef, 9.5; 95% CI: 0.11-1.11; P<0.0001) and female sex (Coef, 2.4; 95% CI: 0.17-0.41; P=0.02) were predictive of prolonged length of hospital stay (68). However, in the mid-term (3-year), sex of the patient has not been significantly associated with RFD (18).…”

Section: Longer-term Evidencementioning

confidence: 75%

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Renal outcomes of suprarenal vs. infrarenal endograft fixation in endovascular abdominal aortic aneurysm repair: a narrative review

Geragotellis¹,

Cox²,

Yip³

et al. 2022

Cardiovasc Diagn Ther

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Background and Objective: Abdominal aortic aneurysm (AAA) is a common pathology with a prevalence of 4.8%. AAA rupture is associated with significant mortality and so early diagnosis followed by regular monitoring is needed until treatment might be considered and plan intervention. Endovascular aneurysm repair (EVAR) is an established and effective alternative to open surgical repair (OSR) in the treatment of AAAs. Key parameters in defining conventional EVAR suitability include the infrarenal neck length and angulation for the fixation of the proximal graft component. Endograft fixation can be either suprarenal or infrarenal and much debate exists as to which approach is associated with optimum renal outcomes. This study aims to review the current literature with respect to the renal outcomes associated with conventional EVAR using suprarenal fixation (SRF) vs. infrarenal fixation (IRF).Methods: A search was conducted from major search indices (PubMed, Google Scholar and EMBASE) to identify relevant literature pertaining to renal outcomes in EVAR. Recent papers comparing SRF and IRF were evaluated and their findings discussed.

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Section: Longer-term Evidencementioning

confidence: 75%

“…It is likely those with pre-existing renal insufficiency are prone to poorer EVAR outcomes when SRF is used (39,61,67,68). This may be complicated by non-randomised selection for SRF but possibly depends on surgical experience and the extent of aortic neck morphology (70,71).…”

Section: Longer-term Evidencementioning

confidence: 99%

Renal outcomes of suprarenal vs. infrarenal endograft fixation in endovascular abdominal aortic aneurysm repair: a narrative review

Geragotellis¹,

Cox²,

Yip³

et al. 2022

Cardiovasc Diagn Ther

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“…However, in their study, patients with baseline renal insufficiency did have a higher risk of progression to dialysis with supra-renal fixation ( P = .039). 26 We compared co-existing variables between supra and infra renal fixation patients and noted infra-renal fixation patients to have higher baseline creatinine, larger aneurysms, and higher rates of diabetes. Also, supra-renal fixation patients had longer hospital stays on average which creates increased time to capture rising creatinine level.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Renal Decline and New Onset Dialysis Following Endovascular Aneurysm Repair in the Vascular Quality Initiative

DeJong

Peterson

Zielke

et al. 2022

Vasc Endovascular Surg

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Introduction The purpose of this study is to identify variables significantly associated with renal function decline after elective endovascular infra-renal abdominal aortic aneurysm repair and to identify the rate and risks of subsequent progression to dialysis. Specifically, we investigate the long-term impact of supra-renal fixation, female gender, and physiologically stressful perioperative events on renal function following endovascular aneurysm repair (EVAR). Methods Review of all EVAR cases in the Vascular Quality Initiative between 2003 and 2021 was conducted to investigate variable associations with three primary outcomes: postoperative acute renal insufficiency (ARI); greater than 30% decline in glomerular filtration rate (GFR) in patients beyond 1 year of follow up; and new onset dialysis requirement at any point in follow up. Binary logistic regression analysis was performed for the events of acute renal insufficiency and new onset dialysis requirement. Cox proportional hazard regression was performed regarding long term GFR decline. Results Postoperative ARI occurred in 3.4% (1692/49 772) of patients. Significant ( P < .05) association with postoperative ARI was noted for: age (OR 1.014/year, 95% CI 1.008-1.021); female gender (OR 1.44, 95% CI 1.27-1.67); hypertension (OR 1.22, 95% CI 1.04-1.44); chronic obstructive pulmonary disease (OR 1.34, 95% CI 1.20-1.50); anemia (OR 4.24, 95% CI 3.71-4.84); reoperation at index admission (OR 7.86, 95% CI 6.47-9.54); baseline renal insufficiency (OR 2.29, 95% CI 2.03-2.56); larger aneurysm diameter; increased blood loss; and higher volumes of intra-operative crystalloid. Risk factors ( P < .05) correlating with a decline of 30% in GFR at any time beyond 1 year were: female gender (HR 1.43, 95% CI 1.24-1.65); body mass index (BMI) less than 20 (HR 1.34, 95% CI 1.03-1.74); hypertension (HR 1.38, 95% CI 1.15-1.64); diabetes (HR 1.34, 95% CI 1.17-1.53); COPD (HR 1.21, 95% CI 1.07-1.37); anemia (HR 1.92, 95% CI 1.52-2.42); baseline renal insufficiency (HR 1.31, 95% CI 1.15-1.49); absence of discharge ace-inhibitor (HR 1.27, 95% CI 1.13-1.42); long term re-intervention (HR 2.43, 95% CI 1.84-3.21) and larger AAA diameter. Patients who experienced long term GRF decline had a significantly higher long-term morality. New onset dialysis following EVAR occurred in .47% (234/49 772) of those meeting inclusion criteria. Higher rate (P < .05) of new onset dialysis was associated with age (OR 1.03/year, 95% CI 1.02-1.05); diabetes (OR 1.376, 95% CI 1.005-1.885); baseline renal insufficiency (OR 6.32, 95% CI4.59-8.72); Reoperation at index admission (OR 2.41, 95% CI 1.03-5.67); postoperative ARI (OR 23.29, 95% CI 16.99-31.91); absence of beta blocker (OR 1.67, 95% CI 1.12-2.49); long term graft encroachment on renal arteries (OR 4.91, 95% CI 1.49-16.14). Conclusions New onset dialysis following EVAR is a rare event. Perioperative variables influencing renal function following EVAR include blood loss, arterial injury, and reoperation. Supra-renal fixation is not associated with postoperative acute renal insufficiency or new onset dialysis in long term follow up. Renal protective measures are recommended for patients with baseline renal insufficiency undergoing EVAR as acute renal insufficiency following EVAR portends a 20-fold increased risk of new onset dialysis in long term follow up.

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Suprarenal vs Infrarenal Fixation

Spanos,

Giannoukas

2024

Mastering Endovascular Techniques

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Proximal fixation of endovascular aortic device may not be associated with renal function decline after abdominal aortic aneurysm repair

Cited by 4 publications

References 14 publications

Renal outcomes of suprarenal vs. infrarenal endograft fixation in endovascular abdominal aortic aneurysm repair: a narrative review

Renal outcomes of suprarenal vs. infrarenal endograft fixation in endovascular abdominal aortic aneurysm repair: a narrative review

Investigation of Renal Decline and New Onset Dialysis Following Endovascular Aneurysm Repair in the Vascular Quality Initiative

Suprarenal vs Infrarenal Fixation

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