title: Repeated contrast medium application after endovascular aneurysm repair and not the type of endograft fixation seems to have deleterious effect on the renal function.
abstract: OBJECTIVE
  The influence of endovascular aneurysm repair (EVAR) on renal function is of high concern. The question whether stent graft fixation type plays a significant role in renal outcome after EVAR is still debated. However, other factors, such as repeated contrast medium exposure, should also be considered.
  
  
  METHODS
  We performed a two-center, stratified-cohort case control study to evaluate the influence of last-generation abdominal endografts with suprarenal (SR) vs infrarenal (IR) fixation on renal function.
  
  
  RESULTS
  From a total of 276 patients, 134 were treated with IR fixation (group A) and 142 with SR fixation (group B) stent grafts. There was no significant difference in intraoperative contrast medium use (mean 120.0 mL group A vs 104.8 mL; P = .087) between the two cohorts. Overall, 11.2% of the patients (31/276) showed a relevant decline (≥20%) of estimated glomerular filtration rate (eGFR) postoperative and 11.5% (31/269) after 12 months. Furthermore, 19/134 (14.2%) patients in group A and 12/142 (8.5%) patients in group B showed a postoperative decrease of eGFR ≥20% (P = .132). Comparing the 12-month follow up, there was also no significant difference between the two groups (group A, n = 18/134; group B, n = 13/135; P = .329). Patients with only one contrast-enhanced computed tomography scan postoperatively (4/102; 3.9%) showed significant less renal deterioration after 12 months compared with the rest of the study collectively (27/166; 16.9%; P = .002). Comparing IR vs SR fixation in these patients, there was no significant difference between the two groups. One patient (1/35; 2.9%) with IR fixation (group A) and 3/67 (4.5%) with SR fixation (group B) showed a decline in eGFR values of ≥20% after 12 months (P = 1.0).
  
  
  CONCLUSIONS
  Our study showed no significant difference in renal impairment between SR and IR fixation in EVAR for IR abdominal aortic aneurysm. However, significantly more renal deterioration was observed in patients with increased postoperative contrast medium expose. Therefore, alternatives such as contrast- enhanced duplex ultrasound or magnetic resonance imaging for EVAR surveillance should be considered.
authors: Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany. Electronic address: daphne.gray@uk-koeln.de.
authors: Daphne Elisabeth
authors: DE
authors: Gray
authors: Clinic of Vascular and Endovascular Surgery, University of Münster, Münster, Germany.
authors: Markus
authors: M
authors: Eisenack
authors: Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany.
authors: Michael
authors: M
authors: Gawenda
authors: Clinic of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular and Endovascular Surgery, St. Franziskus Hospital, University of Münster, Münster, Germany.
authors: Giovanni
authors: G
authors: Torsello
authors: Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany.
authors: Payman
authors: P
authors: Majd
authors: Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany.
authors: Jan
authors: J
authors: Brunkwall
authors: Department of Medical Informatics, University of Münster, Münster, Germany.
authors: Nani
authors: N
authors: Osada
authors: Department of Vascular and Endovascular Surgery, St. Franziskus Hospital, University of Münster, Münster, Germany.
authors: Konstantinos P
authors: KP
authors: Donas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000009:adverse effects* / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D000072226:Computed Tomography Angiography / Q000009:adverse effects*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media