title: Relationship of proximal fixation to postoperative renal dysfunction in patients with normal serum creatinine concentration.
abstract: OBJECTIVE
  This study was performed to determine whether there is deterioration in renal function during follow-up in patients who have undergone endovascular aneurysm repair (EVAR), as recommended by the device manufacturers; to determine whether suprarenal fixation correlates with impairment of renal function; and to explore the potential implication of life-long surveillance of renal function with contrast-enhanced computed tomography.
  
  
  METHODS
  One hundred forty-six consecutive patients underwent EVAR at our institution. Data from 113 of these patients who were free from preoperative renal insufficiency or postoperative renal disease were analyzed. Fifty-three patients received infrarenal (IR) fixation devices, and 60 patients received suprarenal (SR) fixation devices. All SR fixation devices were placed under investigational device exemption protocols. The average follow-up was 688 days. Sixty-five consecutive patients who had undergone open repair of an abdominal aortic aneurysm (AAA) served as the control group.
  
  
  RESULTS
  Preoperative creatinine concentration, intraoperative blood loss, contrast volume, and number of contrast-enhanced procedures were not significantly different between the IR and SR groups. Two renal artery occlusions (1 SR, 1 IR; P=NS) were identified, and 8 renal infarcts (5 SR, 3 IR; P=NS). There was an increase in mean creatinine concentration in the open AAA, IR, and SR fixation groups at each time point in the analysis. Mean elevation in creatinine concentration at 12, 24, and 36 months was 0.10, 0.10, and 0.04 mg/dL, respectively, for open AAA repair; 0.20, 0.21, and 0.28 mg/dL for IR fixation; and 0.15, 0.21, and 0.12 mg/dL for SR fixation. At life table analysis, renal impairment at 36 months was seen in 36% +/- 9% of patients in the IR group, 25% +/- % of patients in the SR group, and 19% +/- 6% of patients in the open AAA group (P=.04 for IR fixation vs open AAA repair).
  
  
  CONCLUSIONS
  A decrease in kidney function is seen after EVAR, regardless of fixation level, that is independent of renal disease and renal arterial occlusion. In patients with normal renal function the site of proximal fixation does not affect postoperative creatinine concentration. The decrease in renal function is likely related to the repetitive administration of contrast agent.
authors.affiliation: Division of Vascular Surgery, University of Rochester Medical Center, NY 14642, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Surowiec
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Fegley
authors.forename: William J
authors.initials: WJ
authors.lastname: Tanski
authors.forename: Vicken N
authors.initials: VN
authors.lastname: Pamoukian
authors.forename: Yaron
authors.initials: Y
authors.lastname: Sternbach
authors.forename: David L
authors.initials: DL
authors.lastname: Waldman
authors.forename: Richard M
authors.initials: RM
authors.lastname: Green
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D051437:Renal Insufficiency / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D003404:Creatinine