title: Endovascular vs open repair of renal artery aneurysms: outcomes of repair and long-term renal function.
abstract: BACKGROUND
  Endovascular treatment (ER) of renal artery aneurysms (RAA) has been widely used recently due to its assumed lower morbidity and mortality compared with open surgery (OS). The purpose of this study was to investigate the outcomes of OS and ER, and compare long-term renal function.
  
  
  METHODS
  Data from 2000 to 2012 were retrospectively collected to identify patients who were treated for RAA in a single institution. Morbidity, mortality, freedom from reinterventions, and renal function were compared between OS and ER for RAA.
  
  
  RESULTS
  Forty-four RAA repairs were identified in 40 patients (28 women, mean age ± SD 54 ± 13 years). Twenty RAA were repaired with OS (45%) and 24 RAA (55%) with ER. Mean aneurysm sizes were 2.5 ± 1.5 cm (OS) and 2.2 ± 2.2 cm (ER; p = 0.66). Endovascular repair included coil embolization with or without stent placement in 19 patients (79%) and stent grafts in 4 (17%). Open surgery included excision or aneurysmorrhaphy of the aneurysm in 11 kidneys (55%), graft interposition or bypass in 4 (20%), and 4 nephrectomies (20%). There was 1 technical failure in each group. Comorbidities were similar between the 2 groups (American Society of Anesthesiologists III-IV: OS, 40%; ER, 58%; p = 0.44). Endovascular repair and OR had equivalent perioperative morbidity (any complication OS, 15%, ER, 17%, p = 1.0) and no mortality (OS, 0%, ER, 0%). Endovascular repair was associated with shorter hospitalization (OS, 6.3 ± 2.5; ER, 2 ± 3.4 days, p < 0.001). Mean follow-ups were 21 ± 32 months (OS) and 27 ± 36 months (ER). A 30% reduction in glomerular filtration rate occurred in 12.5% of OS patients and 9.1% of ER patients (p = 1.00). Freedom from reintervention at 12 and 24 months were OS, 82%/82% and ER, 82%/74%, respectively (log-rank-test = 0.23).
  
  
  CONCLUSIONS
  Endovascular repair of RAA is as safe and effective as open repair in selected patients with appropriate anatomy. There was no difference in decline in renal function between OS and ER.
authors.affiliation: Emory University School of Medicine, Division of Vascular Surgery and Endovascular Therapy, Atlanta, GA, USA. n.tsilimparis@uke.de
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
authors.forename: James G
authors.initials: JG
authors.lastname: Reeves
authors.forename: Anand
authors.initials: A
authors.lastname: Dayama
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Perez
authors.forename: E Sebastian
authors.initials: ES
authors.lastname: Debus
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Ricotta
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000601:surgery*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012077:Renal Artery / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D058017:Vascular Grafting
keywords: ER; FMD; GFR; OS; RAA; endovascular treatment; fibromuscular dysplasia; glomerular filtration rate; open surgery; renal artery aneurysm