The impact of aortic endografts on renal function

Alsac, Jean Marc; Zarins, Christopher K.; Heikkinen, Martti; Karwowski, John K.; Arko, Frank R.; Desgranges, Pascal; Roudot‐Thoraval, Françoise; Becquemin, J. P.

doi:10.1016/j.jvs.2005.02.024

Cited by 84 publications

(93 citation statements)

References 37 publications

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“…243 Other smaller studies comparing renal function after EVAR or open repair have also shown a deterioration in renal function, with one study demonstrating similar decline between types of repair 244 and two others showing greater deterioration after EVAR. 245,246 Several studies have compared suprarenal versus infrarenal fixation during EVAR, and these support a deterioration in renal function after EVAR [247][248][249][250][251][252][253] but demonstrate little difference between suprarenal or infrarenal fixation. A meta-analysis of these studies provided conflicting results according to the analytical method used and concluded that the data were insufficient to draw any strong conclusions on the impact of suprarenal fixation.…”

Section: Renal Functionmentioning

confidence: 99%

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Brown

Powell²,

Thompson³

et al. 2012

Health Technol Assess

207

170

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

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Section: Renal Functionmentioning

confidence: 99%

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Brown

Powell²,

Thompson³

et al. 2012

Health Technol Assess

207

170

View full text Add to dashboard Cite

show abstract

“…Although recent studies have shown that progressive renal dysfunction may develop in patients after EVAR, data are conflicting with regard to the effects of EVAR on renal function compared with standard open repair. [8][9][10] In addition, EVAR is usually possible if patients have the appropriate anatomical morphology. It is thought that more contrast enhanced media is needed for patients who were not suitable for EVAR, because their procedures are more difficult and additional devices are used.…”

Section: Introductionmentioning

confidence: 99%

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

Guntani

Okadome

Kawakubo

et al. 2012

Annals of Vascular Diseases

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Objective: Chronic renal insufficiency may be a relative contraindication to endovascular aneurysm repair (EVAR) for the use of contrast enhanced mediums. It is thought that more contrast enhanced media are needed in patients who are not anatomically suitable for EVAR, because of procedural difficulties. We reviewed a 2 year EVAR experience at our institution to determine whether the procedure and use of contrast enhanced mediums has any deleterious effect on renal function in patients with pre-existing chronic renal insufficiency. Materials and Methods: EVAR was performed in 46 patients with pre-existing chronic renal insufficiency without hemodialysis. Patients were retrospectively assigned to two groups on the basis of their preoperative creatinine clearance levels. Furthermore, patients were assigned to two other groups on the basis of anatomical suitability for EVAR. The absolute change in the serum creatinine (Cr) level was reviewed in the each renal insufficiency group between the preoperative and post-operative time periods. Results: No increase in the serum Cr level was noted, and no patient required temporary or permanent hemodialysis, in any of the groups. Conclusions: EVAR with contrast agents can be accomplished in patients with chronic renal insufficiency without hemodialysis; therefore,elevated Cr levels maynot be a contraindication in EVAR.

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“…In addition to the risk factors mentioned above, renal atheroembolism, renal artery trauma, stent-induced renal artery stenosis or occlusion, and blood loss that may occur during the EVAR may contribute to further exacerbation of renal dysfunction (9). Several studies have shown that both open aortic repair and EVAR can cause transient or permanent alterations in renal function, but hemodialysis is rarely required (9)(10)(11)(12). Thus, the volume of ICM used during the endovascular procedure is very important, especially in patients with long-standing diabetes mellitus and renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Reduction of iodinated contrast load with the renal artery catheterization technique during endovascular aortic repair

Canyiğit

Çetín²,

Uğuz³

et al. 2012

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to present our clinical experience with the renal artery catheterization (RAC) technique, which reduces the volume of intra-arterial contrast media (ICM) used during endovascular aortic repair (EVAR), and describe the short-term results of this technique. MATERIALS AND METHODSWe retrospectively evaluated 16 patients (15 males and one female) who underwent EVAR between March 2011 and February 2012 using the RAC technique for an abdominal aortic aneurysm. A Simmons-1 catheter was preferred for renal artery cannulation. The mean age of the patients at the time of treatment was 70 years (range, 61-82 years). Fifteen cases were fusiform aneurysms, and one case was a saccular aneurysm. Creatinine and estimated glomerular filtration rate (eGFR) values were recorded before the procedure and during the first 72 hours postprocedure. RESULTSBifurcated stent grafts were implanted with 100% procedural success using the RAC technique. The inferiorly positioned renal artery was cannulated with a Simmons-1 catheter in the first five patients, and was maintained at the level of the renal artery orifice in the remaining patients. The mean volume of the ICM used was 47 mL (range, 23-83 mL). The creatinine and eGFR values were not significantly different between the pre-and postoperative periods (P > 0.05). CONCLUSIONReducing the volume of ICM used during EVAR is critical for protecting renal function. The RAC technique is a safe and effective method in appropriate patients when performed by experienced clinicians.A lthough contrast medium induced nephropathy (CIN) is a rare occurrence in patients with serum creatinine levels less than 132 µmol/L (1.5 mg/dL) or a preferred estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m 2 with an incidence less than 2%, it is more prominent in patients with diabetic nephropathy (19.7%) and pre-existing renal impairment (3%-33%) (1). Patients who undergo endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) are often elderly, and diabetes mellitus and/or renal impairment are common in this group of patients (2, 3). Dehydration, congestive heart failure, multiple myeloma, and concurrent use of nephrotoxic drugs as well as larger doses of contrast media and multiple injections within 72 hours are also risk factors for CIN (1, 4). In addition, intra-arterial contrast media (ICM), especially when given into the renal arteries or the aorta at the origins of the renal artery, as in EVAR, is more nephrotoxic than intravenous administration (1, 4). Furthermore, pre-and postoperative computed tomography (CT) angiographies as well as EVAR can also cumulatively increase the risk of CIN.Although strategies used for solving contrast related problems have improved over the years as a result of the development of contrast agents, contrast-related morbidity is still a serious issue. To avoid the adverse effect of contrast media, carbon dioxide angiography and intravascular ultrasonography (IVUS) have been assessed as an alternative strate...

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The impact of aortic endografts on renal function

Cited by 84 publications

References 37 publications

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

Reduction of iodinated contrast load with the renal artery catheterization technique during endovascular aortic repair

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