title: Suprarenal graft fixation in endovascular abdominal aortic aneurysm repair is associated with a decrease in renal function.
abstract: BACKGROUND
  Suprarenal endograft fixation is routinely used in the endovascular repair of abdominal aortic aneurysms (EVAR) to enhance proximal endograft attachment but can be associated with an adverse outcome in renal function. This prospective study assessed the effect of suprarenal fixation on serum creatinine concentration and estimated glomerular filtration rate (eGFR), calculated by the Modified Diet in Renal Disease equation, 12 months after elective EVAR.
  
  
  METHODS
  Patients undergoing elective EVAR were divided into suprarenal vs infrarenal fixation groups matched for age, sex, smoking, and aneurysm diameter. Serum creatinine and eGFR were measured at baseline, 6, and 12 months.
  
  
  RESULTS
  Included were 92 patients (two women) with a mean age of 71 ± 7 years, with 46 in each group. No device-related complications were noted. Serum creatinine did not differ significantly between groups at 6 (P = .24) or 12 (P = .08) months but significantly increased in the suprarenal group at 12 months (1.08 ± 0.36 to 1.16 ± 0.36 mg/dL; P < .001) vs baseline. The eGFR (mL/min/1.73 m(2)) did not differ significantly at baseline between the suprarenal (85 ± 27) and infrarenal (80 ± 28; P = .33) groups or at 6 months (88 ± 29 vs 77 ± 24, respectively; P = .07). At 12 months, the suprarenal group had a lower eGFR (73 ± 23) than the infrarenal group (84 ± 26; P = .027). The eGFR at 12 months showed a significant decrease in the suprarenal (80 ± 28 to 73 ± 23; P < .001) but not in the infrarenal group (85 ± 27 to 84 ± 26; P = .48). The drop in eGFR differed significantly at 12 months in the infrarenal vs the suprarenal (0.82 vs -6.94; P < .001) group. No patient progressed to end-stage renal disease or disclosed a drop in eGFR > 30%.
  
  
  CONCLUSIONS
  In contrast to previous studies, this study suggests that suprarenal endograft fixation in elective EVAR is associated with a drop in eGFR at 12 months.
authors.affiliation: Directorate of Research and Development, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, United Kingdom. a_saratzis@yahoo.gr
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.forename: Pantelis
authors.initials: P
authors.lastname: Sarafidis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Melas
authors.forename: James P
authors.initials: JP
authors.lastname: Hunter
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Saratzis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kiskinis
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D004739:England; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine