title: F-EVAR does not Impair Renal Function more than Open Surgery for Juxtarenal Aortic Aneurysms: Single Centre Results.
abstract: OBJECTIVE
  To compare the results of elective open surgical repair (OSR) and total endovascular repair of juxtarenal aortic aneurysms (JAA), with either the Cook Zenith or the Vascutek Anaconda fenestrated stent grafts (F-EVAR) in a university hospital setting.
  
  
  METHODS
  Between April 1999 and July 2014, of 926 patients with an abdominal aortic aneurysm, 69 were juxtarenal, where 34 had an elective OSR and 35 had F-EVAR. A post-operative rise of baseline creatinine by >50% and/or deterioration of estimated glomerular filtration rate by 25% were defined as renal failure.
  
  
  RESULTS
  The demographics of the patients were similar except for heart insufficiency, peripheral arterial disease, and pre-existing renal artery stenosis (p < .05). Median aneurysm diameters were 57 mm (range 50-80 mm) and 56 mm (range 36-64 mm) (p = .194), respectively, and the median pre-operative serum creatinine levels were 94 μmol/L (range 65-286 μmol/L) and 96 μmol/L (range 57-333 μmol/L) (p = .871) with median estimated glomerular filtration rate of 68 mL/min (range 21-117 mL/min) and 70 mL/min (range 18-114 mL/min) (p = .308) in the open and endovascular groups, respectively. The technical success (OSR versus F-EVAR) was 100% versus 94.3% with complete exclusion of the aneurysms in all cases. Median procedure time was 171 versus 188 min. During median in hospital stay of 11 versus 7 days (p = .05), mortality was 0 versus 2.9% and new onset of post-operative renal insufficiency was detected in 26.5% versus 8.5% patients (p = .05), although with 11.8% versus 5.7% being persistent (p = .428). During follow up, statistically similar new (late or persistent post-operative) renal insufficiency was detected in 14.7% versus 8.8% with dialysis in 3% of patients in each group with similar mortality within the 24 months.
  
  
  CONCLUSIONS
  This retrospective analysis demonstrates that OSR might be combined with more acute post-operative renal impairment than F-EVAR for JAA, but with similar intermediate term procedure related mortality and renal outcomes.
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Shahverdyan
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: M P
authors.initials: MP
authors.lastname: Majd
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Thul
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Braun
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gawenda
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany. Electronic address: jan.brunkwall@uk-koeln.de.
authors.forename: J
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D003404:Creatinine / Q000097:blood; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D006785:Hospitals, University; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Aortic aneurysm; Endovascular repair; F-EVAR; Fenestrated; Juxtarenal aorta; Open repair; Stent graft