Suprarenal fixation of Endograft in abdominal aortic aneurysm treatment: Focus on renal function

• Published in: Annals of surgery 2004-07, Vol.240 (1), p.169-178
• Main Authors: GREGO, Franco, FRIGATTI, Paolo, ANTONELLO, Michele, LEPIDI, Sandro, RAGAZZI, Roberto, IURILLI, Vincenzo, ZUCCHETTA, Pietro, DERIU, Giovanni P
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Cardiology. Vascular system; Creatinine - blood; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; General aspects; Glomerular Filtration Rate; Humans; Kidney - diagnostic imaging; Kidney - physiopathology; Male; Medical sciences; Middle Aged; Original; Radioisotope Renography; Stents; Technetium Tc 99m Pentetate
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/01.sla.0000130721.78358.63

The objective of this work was to evaluate any variation of renal function detected by renal scintigraphy after the suprarenal fixation of endografts for abdominal aortic aneurysm (AAA) repair. In the few articles that have considered this problem, renal function was evaluated only by biochemical tests, which are inadequate in demonstrating small changes in renal function and in appreciating the worsening of a single kidney's function. Between April 1999 and May 2002, 47 patients with an inappropriate infrarenal proximal neck had a suprarenal fixation for AAA. To assess renal function, a technetium-99m diethylene triamine penta-acetic acid (TC-DTPA) perfusion scintigraphy was performed preoperatively on the third postoperative day and at 6, 12 months, and then yearly thereafter. Worsening of renal function was defined as a decrease of glomerular filtration rate (GFR) > or =20% (detected with Gates method). Serum creatinine level was tested preoperatively and at the first and third postoperative day. Endograft deployment was technically successful in 44 patients (93.6%); clinical perioperative success was obtained in 46 patients (97.8%). In 12 patients (25.5%), a permanent reduction of the GFR was observed using postoperative TC-DTPA perfusion scintigraphy. By 99m TC-DTPA perfusion scintigraphy, a permanent reduction of GFR was observed postoperatively in 12 patients. A slight GFR reduction (20%) was present unexpectedly in 5 (10.6%) patients, in 3 of these a single kidney was involved, in 5 both with an increase of the serum creatinine level >20%. Suprarenal fixation of endografts in AAA treatment is a safe procedure with good early and midterm procedural results and a risk of GFR impairment (>20%) of 10.6%.