title: Editor's Choice - Comparison of Renal Outcomes in Patients Treated by Zenith®Fenestrated and Zenith®Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials.
abstract: Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined.
  
  
  
  Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years.
  
  
  
  AKI at 1 month was similar between groups, with > 25% decline in eGFR observed in 5% of FEVAR and 9% of EVAR patients (p = .39). There were no significant differences in > 25% decline in eGFR at 2 years (FEVAR 20% vs. EVAR 20%; p > .99) or 5 years (FEVAR 27% vs. EVAR 50%; p = .50). Progression to stage IV-V CKD was similar at 2 years (FEVAR 2% vs. EVAR 3%; p > .99) and 5 years (FEVAR 7% vs. EVAR 8%; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22%] vs. 3/134 [2%]; p < .001) and renal related re-interventions (12/67 [18%] vs. 4/134 [3%]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5% vs. 1.5%; p > .99).
  
  
  
  Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.
authors.affiliation: Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA; Surgery PhD Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: L R
authors.initials: LR
authors.lastname: de Souza
authors.affiliation: Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: oderich.gustavo@mayo.edu.
authors.forename: G S
authors.initials: GS
authors.lastname: Oderich
authors.affiliation: Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Farber
authors.affiliation: Aortic Center, CHRU Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA; Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
authors.forename: P V
authors.initials: PV
authors.lastname: Banga
authors.affiliation: Surgery PhD Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: A H
authors.initials: AH
authors.lastname: Pereira
authors.affiliation: Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: P
authors.initials: P
authors.lastname: Gloviczki
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Textor
authors.affiliation: Cook Research Incorporated, West Lafayette, IN, USA.
authors.forename: F
authors.initials: F
authors.lastname: Jia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005919:Glomerular Filtration Rate; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D011474:Prosthesis Design; D006435:Renal Dialysis; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Acute kidney injury; Aortic aneurysm; Chronic kidney disease; FEVAR