title: Altered renal functions in patients with occlusion of an accessory renal artery after endovascular stenting of an infrarenal aneurysm.
abstract: OBJECTIVE
  Coverage of an accessory renal artery (ARA) during endovascular aneurysm repair (EVAR) may result in renal infarction (RI) or decline in renal function. Until now, it remains vague which patients are at risk to develop these complications. We therefore analyzed the effect of ARA sealing by EVAR with respect to the occurrence of RI and renal function.
  
  
  METHODS
  A retrospective analysis of the medical records and computed tomographic scans of patients who underwent EVAR within a period of 5 years was performed. Particular attention was paid to the presence or absence of accessory renal arteries and renal function before EVAR. Thirty-four patients with ARA were matched 1:3 to 102 patients without ARA. The results after EVAR were analyzed in patients with and without ARA. In patients with ARA, we further examined the results after EVAR in patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min and eGFR < 60 mL/min before EVAR.
  
  
  RESULTS
  Before EVAR, the median eGFR was 74 mL/min (25th/75th percentiles, 57/89) in patients with ARA and 72 mL/min (25th/75th percentiles, 63/87) in patients without ARA. Alterations in eGFR were significantly pronounced in patients with ARA when compared with patients without ARA 1 week after EVAR (ARA, -10.7 ± 16.9 mL/min vs without ARA, 1.2 ± 13.3 mL/min; P = .002) and after 6 months (ARA, -10.8 ± 17.4 mL/min vs without ARA, 1.2 ± 13.3 mL/min; P = .001). RI only occurred in patients with ARA. Within the group of patients with ARA, patients with normal renal function (NF) showed a more pronounced decline in eGFR preoperatively when compared with patients with impaired renal function (IF) 1 week after EVAR (NF, -14.3 ± 18.0 mL/min vs IF, -1.3 ± 10.8 mL/min; P = .02) and after 6 months (NF, -15.8 ± 17.9 mL/min vs IF, 0.1 ± 15.2 mL/min; P = .007).
  
  
  CONCLUSIONS
  The decrease in renal function was more pronounced in patients with ARA after EVAR when compared with patients without ARA undergoing EVAR. In patients with ARA, the observed decline in renal function was significantly distinct in patients presenting NF preoperatively. Consequently, the risk of IF after EVAR seems to be increased in patients with ARA and normal preoperative renal function.
authors.affiliation: Department of Vascular Surgery, Erding Hospital, Erding, Germany; Department of Surgery, University of Munich (LMU), Munich, Germany.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Sadeghi-Azandaryani
authors.affiliation: Department of Radiology, University of Munich (LMU), Munich, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Zimmermann
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland.
authors.forename: Insa
authors.initials: I
authors.lastname: Korten
authors.affiliation: Department of Vascular Surgery, Erding Hospital, Erding, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Klose
authors.affiliation: Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Scheiermann
authors.affiliation: Department of Radiology, University of Munich (LMU), Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
authors.affiliation: Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany. Electronic address: jens.heyn@med.uni-muenchen.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Heyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012077:Renal Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome