Transrenal fixation of aortic stent-grafts: short- to midterm effects on renal function--a systematic review.
OBJECTIVE
To perform a systematic review of the short- to midterm effects of transrenal fixation of aortic stent-grafts on renal function in patients with abdominal aortic aneurysms.


METHODS
A search of the PubMed, MEDLINE, and EMBASE databases for English-language literature was performed. Studies with at least 10 patients were included for data analysis. Only studies on transrenal fixation of aortic stent-grafts that included follow-up results for renal function were included. A log-linear model was used for meta-analysis to compare transrenal fixation with infrarenal fixation.


RESULTS
Twenty-two studies met the inclusion criteria. Because two studies analyzed the same group of patients, one was excluded, for a total of 21 studies. Comparisons between transrenal fixation and infrarenal fixation were found in seven studies. For transrenal versus infrarenal fixation, the combined odds ratio, 95% confidence interval, and P value were found to be statistically significant with respect to postprocedural renal infarction only (combined odds ratio, 5.189; 95% confidence interval: 3.198, 8.420; P < .001). No significant difference was found between transrenal and infrarenal fixation with respect to renal dysfunction, renal artery occlusion, or endoleaks (P > .05).


CONCLUSIONS
Transrenal fixation of aortic stent-grafts seems to be a relatively safe alternative compared with infrarenal fixation in terms of short- to midterm follow-up. Postprocedural renal infarction, however, was significantly higher for transrenal fixation.
Sun
Zhonghua
Z
School of Health Sciences, University of Ulster, Newtownabbey, Northern Ireland, UK. z.sun@curtin.edu.au
Stevenson
Gil
G
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D019317:Evidence-Based Medicine; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology*; D016014:Linear Models; D011183:Postoperative Complications / Q000453:epidemiology; D012077:Renal Artery; D015607:Stents / Q000009:adverse effects*
D003404:Creatinine