Comparison of renal function after endovascular aneurysm repair with different transrenally fixated endografts

• Published in: Journal of vascular surgery 2006-11, Vol.44 (5), p.938-942
• Main Authors: Forbes, Thomas L., Harding, Gregory E.J., Lawlor, D. Kirk, DeRose, Guy, Harris, Kenneth A.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - metabolism; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Creatinine - metabolism; Diseases of the aorta; Female; Follow-Up Studies; Humans; Kidney - physiopathology; Male; Medical sciences; Middle Aged; Prosthesis Design; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Suture Techniques; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2006.07.038

Transrenal fixation of abdominal aortic endografts may provide a more secure proximal attachment with few deleterious effects with respect to renal function. This study’s purpose was to determine whether different metals used in two commercially available endografts (Cook Zenith and Medtronic Talent) result in different effects on renal function when placed across renal ostia. A total of 140 consecutive patients, between August 2003 and April 2005, who underwent elective endovascular repair of an aortic aneurysm with a nitinol or stainless steel–based endograft with transrenal fixation were reviewed with a mean follow-up period of 5.5 months (range, 1-22 months). The main outcome variable was the percentage change in creatinine clearance (CrCl), which was determined before surgery and at the most recent follow-up. Multiple regression analysis was performed to analyze the contribution of various factors to any deterioration in renal function. The 140 patients were predominantly male (86%), with a mean age of 75 years (range, 56-92) and a mean aneurysm diameter of 62 mm (range, 42-110 mm). The mean intraoperative contrast use was 67 mL (range, 45-160 mL), and after surgery these patients received a mean of 3 surveillance computed tomographic scans (range, 1-7). Nineteen cases (13.6%) required deliberate accessory renal artery coverage. CrCl did not change significantly after surgery; the mean change in CrCl at the end of follow-up was a 2.5% decrease. There was no difference in the reduction in CrCl between endograft types. Only 14.3% of patients experienced a greater than 20% decrease in CrCl. Multiple regression analysis failed to show a relationship between change in renal function and age, sex, aneurysm diameter, infrarenal neck dimensions, endograft type, coverage of accessory renal arteries, intraoperative contrast volume, preoperative CrCl, and postoperative computed tomographic scans. Length of follow-up was an independent predictor (P = .04). Transrenal endograft fixation results in little deterioration in renal function during intermediate follow-up. The few patients who do experience a decline in renal function do so independently of any features related to the initial endovascular repair, and there is no difference in renal deterioration between endografts with nitinol and stainless steel transrenal bare metal stents.