title: Comparison of the impact of open and endovascular abdominal aortic aneurysm repair on renal function.
abstract: OBJECTIVE
  The impact of any intervention on renal function is a crucial determinant of outcome. Open (OR) and endovascular (EVAR) abdominal aortic aneurysm (AAA) repair can affect renal function during the short and longer term. This study aimed to directly compare the effect of those different types of aneurysm repair during a period of 2 years.
  
  
  METHODS
  This was a nested case-control study including patients undergoing either OR or EVAR of an infrarenal AAA. Three groups were included: OR, EVAR with suprarenal endograft fixation, and EVAR with infrarenal fixation. These were matched for age (within 2 years), sex, AAA size (within 1 cm), hypertension, smoking, and proximal neck diameter (within 5 mm). The primary end point was change in estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration formula at baseline, 6 months, 12 months, and 2 years.
  
  
  RESULTS
  A total of 225 patients were included [(45 ORs matched vs 90 suprarenal and 90 infrarenal fixation EVARs; 35 women (16%); age, 71 ± 8 years; AAA size, 6.4 ± 1 cm]. Groups did not differ significantly in terms of diabetes, hypercholesterolemia, or baseline eGFR (P = .89). On average, those undergoing OR lost a mean 5.39 mL/min/1.73 m(2) (P = .48) within 1 year and 5.49 units (P = .42) after 2 years. The suprarenal fixation patients lost 5.58 units (P = .002) after 1 year and 6.57 units (P = .001) after 2 years. Finally, the infrarenal fixation patients lost 0.53 unit (P = .74) after 1 year and 2.24 units (P = .22) after 2 years.
  
  
  CONCLUSIONS
  OR and suprarenal fixation EVAR are associated with significant declines in renal function during 2 years, in contrast to infrarenal EVAR fixation. The patterns of eGFR decline in OR and suprarenal fixation EVAR are not similar, suggesting different causal mechanisms.
authors.affiliation: Department of Research and Development, Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom; Department of Vascular Surgery, Aristotle University, Thessaloniki, Greece; Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: a_saratzis@yahoo.gr.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University, Thessaloniki, Greece.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Sarafidis
authors.affiliation: Department of Vascular Surgery, Aristotle University, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Melas
authors.affiliation: Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: Harmeet
authors.initials: H
authors.lastname: Khaira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005060:Europe; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome