Endovascular abdominal aortic aneurysm repair and renal complications: a comparison between suprarenal and infrarenal fixation of stent grafts.
OBJECTIVE
This study was performed to compare the rate of morphological (renal infarction and/or ischaemic lesions) and functional renal complications after the suprarenal and infrarenal fixation of aortic stent-grafts for endovascular abdominal aortic aneurysm repair (EVAR).


METHODS
We retrospectively reviewed all followup computed tomography (CT) angiograms (obtained at 1, 6 and 12 months and yearly thereafter) and laboratory data pertaining to 102 patients who underwent suprarenal (60 patients, group A) or infrarenal (42 patients, group B) placement of aortic stent-grafts. The groups were compared in terms of complications affecting kidney function (creatinine clearance) and morphology (renal artery steno-occlusions, morphological and structural parenchymal changes), and pre- and postprocedural arterial pressure (AP).


RESULTS
Analysis of patient demographics revealed no statistically significant difference between the two groups. The proximal neck was shorter in group A (2.14 cm+/-0.84 cm) than in group B (3.41 cm+/-1.21 cm). Creatinine clearance (CrCl) decreased in both groups (group A: from 64.24 ml/min to 60.66 ml/min; group B: from 72.41 ml/min to 68.73 ml/min) without any significant difference in terms of changes in renal function (CrCl variation: -8.75% vs. -6.4%) or morphology (post-EVAR stenosis: 2.6% vs. 0%; progression of existing steno-occlusive lesions: 1% vs. 0%; ischaemic lesions: 3.2% vs. 0%), or in AP.


CONCLUSIONS
In our experience, the use of abdominal endografts with suprarenal fixation did not lead to any significant increase in morphological and/or functional renal complications compared with those with infrarenal fixation.
Cotroneo
A R
AR
Dipartimento di Scienze Cliniche e Bioimmagini, Sezione di Scienze Radiologiche, Università degli Studi G. D'Annunzio, Ospedale SS. Annunziata, Via dei Vestini, I-66013, Chieti, Italy. ar.cotroneo@rad.unich.it
Iezzi
R
R
Giancristofaro
D
D
Santoro
M
M
Pierro
A
A
Spigonardo
F
F
Storto
M L
ML
D000368:Aged; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000652:urine; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D003404:Creatinine