title: Impact of Fenestrated Endovascular Abdominal Aortic Aneurysm Repair on Renal Function.
abstract: OBJECTIVE
  To investigate the impact of fenestrated endovascular aneurysm repair (fEVAR) on renal function perioperatively and at midterm.
  
  
  METHODS
  A case-controlled study was performed involving 58 patients (mean age 75±7 years; 51 men) who underwent elective fEVAR for a juxtarenal or short-necked abdominal aortic aneurysm (AAA) matched on age, sex, smoking, diabetes, and baseline estimated glomerular filtration rate (eGFR) with a contemporaneous group undergoing open aneurysm repair (OAR) for the same indications. Perioperative incidence of acute kidney injury (AKI) and levels of eGFR at 30 days and 1 year were compared. A systematic literature review was performed to identify studies that had used eGFR as renal outcome after fEVAR; the pooled data were meta-analyzed using an eGFR drop >30% at 1 month and the latest follow-up as endpoints. Results are reported as the pooled proportion and 95% confidence interval (CI).
  
  
  RESULTS
  The incidence of AKI after fEVAR was 28% compared to 10% after OAR (p=0.03). Following fEVAR, the mean eGFR dropped from 78±8 to 74±9 mL/min/1.73 m(2) at 30 days compared to a change from 79±8 to 80±16 mL/min/1.73 m(2) after OAR (p<0.01). However, the absolute drop in eGFR between fEVAR and OAR at 1 year was similar (7 mL/min/1.73 m(2); p=0.53); 7% of the fEVAR patients had an eGFR drop >30% at that point compared with none for OAR (p=0.12). The systematic literature review identified eGFR outcomes for 193 fEVAR patients. Combining these patients with the 58 from our cohort study, the pooled proportions of eGFR drop >30% were 20% (95% CI 9% to 39%) at 30 days and 8% (95% CI 0.5% to 13%) at the end of follow-up.
  
  
  CONCLUSIONS
  fEVAR has a significant perioperative impact on renal function, but 1-year results are similar to OAR. fEVAR patients may benefit from targeted AKI prevention strategies that need to be assessed in relevant studies.
authors.affiliation: Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Unit, University of Leicester, Leicester Royal Infirmary, Leicester, UK as875@le.ac.uk.
authors.forename: Athanasios N
authors.initials: AN
authors.lastname: Saratzis
authors.affiliation: Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Unit, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Bath
authors.affiliation: Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Unit, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Seamus C
authors.initials: SC
authors.lastname: Harrison
authors.affiliation: Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Unit, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sayers
authors.affiliation: Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Unit, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bown
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male
keywords: abdominal aortic aneurysm; acute kidney injury; estimated glomerular filtration rate; fenestrated endovascular aneurysm repair; juxtarenal aneurysm; renal function; surgery