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

• Published in: Journal of vascular surgery 2021-12, Vol.74 (6), p.1861-1866.e1
• Main Authors: Erben, Young, Li, Y., Mao, Michael A., Hamid, Osman S., Franco-Mesa, Camila, Da Rocha-Franco, Joao A., Stone, William, Fowl, Richard J., Oldenburg, Warner A., Farres, Houssam, Meltzer, Andrew J., Gloviczki, Peter, De Martino, Randall R., Bower, Thomas C., Kalra, Manju, Oderich, Gustavo S., Hakaim, Albert G.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic aneurysm repair; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Disease Progression; Endovascular aortic device; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular repair; Female; Glomerular Filtration Rate; Humans; Kidney - physiopathology; Kidney Diseases - complications; Kidney Diseases - diagnosis; Kidney Diseases - physiopathology; Length of Stay; Male; Prosthesis Design; Proximal fixation; Renal function after abdominal aortic aneurysm repair; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2021.05.050

Significant debate exists among providers who perform endovascular abdominal aortic aneurysm repair (EVAR) regarding the renal function change between suprarenal (SuF) and infrarenal (InF) fixation devices. The purpose of this study is to review our institution's experience using these devices in terms of renal function. This is a retrospective review of all elective EVARs performed within a three-site health system (Florida, Minnesota, and Arizona) during the period of 2000 to 2018. The primary outcome was renal function decline on long-term follow-up depending on the anatomical fixation of the device (SuF vs InF). Secondary outcomes were length of hospitalization (LOH) and progression to hemodialysis. Multivariable regression analysis was performed to test for associations affecting LOH. There were 1130 elective EVARs included in our review. Of those, 670 (59.3%) had SuF and 460 (40.7%) InF. Long-term follow-up was 4.8 ± 3.7 years, and the rate of change in creatinine and estimated glomerular filtration rate (eGFR) were not statistically significant among groups (SuF vs InF). LOH was higher in those individuals with a SuF device (3.4 ± 2.2 vs 2.3 ± 1.0 days; P < .001). Ten patients with chronic kidney disease progressed to hemodialysis at 6.7 ± 3.8 years from EVAR. On Kaplan-Meier analysis, patients with chronic kidney disease with SuF were more likely to progress to hemodialysis (P = .039). On multivariable regression, female sex (Coef, 2.4; 95% confidence interval [CI], 0.17-0.41; P = .02), SuF (Coef, 9.5; 95% CI, 0.11-1.11; P < .0001), and intraoperative blood loss of greater than 150 mL (Coef, 15.4; 95% CI, 0.11-1.76; P < .0001) were predictors of prolonged LOH. Our three-site, single-institution data indicate that, although the starting eGFR was statistically lower in those individuals undergoing elective EVAR with InF, device fixation type did not affect the creatinine and eGFR on long-term follow-up. However, caution should be exercised at the time of abdominal aortic aneurysm repair in those individuals who already presented with renal dysfunction.