Renal function after endovascular aortic aneurysm repair: a single-center experience with transrenal versus infrarenal fixation.
OBJECTIVE
To describe the short-term consequences of endovascular aortic aneurysm repair (EVAR) on renal function after infrarenal (IR) versus transrenal (TR) stent-graft fixation.


METHODS
Between December 1996 and January 2006, 369 consecutive patients were treated with EVAR. All patients had an AneuRx or a Talent stent-graft implanted using IR (AneuRx) or transrenal (Talent) fixation. Post-EVAR, a standardized follow-up scheme included computed tomography (CT) scanning and serum creatinine measurements at 2 days, 3 months, and 12 months. Postoperative renal dysfunction was defined as a >20% decrease in serum creatinine clearance compared to baseline, the presence of new-onset dialysis, or both. Of the 369 patients, 309 (291 men; mean age 71+/-7 years, range 63-82) had complete 1-year follow-up and were included in this study. An IR stent-graft was placed in 190 patients, and a TR stent-graft was placed in the remaining 119 patients.


RESULTS
At discharge, renal dysfunction occurred in 3.7% of the patients in the IR group versus 5.9% in the TR group (p = NS) and rose significantly to 13.7% in the IR group (p = 0.001) and 15.1% in the TR group (p = 0.02) at the 1-year follow-up. However, no significant difference was noted between the IR and TR groups at either time point. At the 1-year follow-up, at least 50% of renal dysfunction was caused by obstructions of (accessory) renal arteries and renal infarctions. During the follow-up interval, 3 (0.97%) of 309 patients underwent new-onset dialysis.


CONCLUSIONS
Both infrarenal and transrenal fixation techniques in EVAR will lead to a significant rise in renal dysfunction during the first year. A few patients with dysfunction will require dialysis.
Waasdorp
Evert
E
Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
van't Hullenaar
Casper
C
van Herwaarden
Joost
J
Kelder
Hans
H
van de Pavoordt
Eric
E
Overtoom
Tim
T
Moll
Frans
F
de Vries
Jean-Paul
JP
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D006435:Renal Dialysis; D012107:Research Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003404:Creatinine