Long-Term Renal Function after Endovascular Aneurysm Repair |
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Authors: | Athanasios Saratzis Michael F Bath Seamus Harrison Robert D Sayers Asif Mahmood Pantelis Sarafidis Matthew J Bown |
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Institution: | *Department of Cardiovascular Sciences and Leicester NIHR Cardiovascular Biomedical Research Unit, Leicester, United Kingdom; and;†University Hospital Coventry and Warwickshire, Coventry, United Kingdom |
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Abstract: | Background and objectivesEndovascular repair (EVAR) is a common treatment for abdominal aortic aneurysm (AAA). However, its long-term effects on renal function remain unclear. We aimed to assess long-term renal dysfunction after EVAR using a contemporary estimate of GFR and to compare long-term renal outcomes in patients after EVAR with open aneurysm repair (OAR) and in patients without an AAA.Design, settings, participants, & measurementsWe performed a nested case-matched analysis of 726 patients (using a prospectively maintained database for repairs that took place between January 2000 and May 2010 in a tertiary center): 121 patients undergoing OAR (with data at baseline and 5 years postrepair) were case matched (age, sex, smoking, diabetes, baseline eGFR) to patients undergoing suprarenal and infrarenal fixation EVAR (242 in each group) and to 121 patients undergoing carotid endarterectomy (CEA) without AAA. Changes in eGFR were compared (1 and 5 years).ResultsThe OAR patients lost an average of 7.4 ml/min per 1.73 m2 at 5 years (95% confidence interval 95% CI], 4.8 to 10.6), compared with 8.2 ml/min per 1.73 m2 (95% CI, 6.5 to 10.8; P<0.001) for infrarenal-fixation EVAR, 16.9 ml/min per 1.73 m2 (95% CI, 13.0 to 21.9, P<0.001) for suprarenal-fixation EVAR, and 5.4 ml/min per 1.73 m2 (95% CI, 1.7 to 7.5; P<0.001) for CEA. The decrease in eGFR was steeper during the first postoperative year, with each group losing −2.2 ml/min per 1.73 m2 (infrarenal-fixation EVAR), −10.7 ml/min per 1.73 m2 (suprarenal-fixation EVAR), and −4.6 ml/min per 1.73 m2 (OAR), compared with −1.9 ml/min per 1.73 m2 for CEA.ConclusionsElective EVAR is associated with a significant decline in eGFR after 5 years, which is steeper in the first postoperative year and more pronounced compared with a similar population with atherosclerotic disease. |
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Keywords: | chronic kidney disease cardiovascular disease endovascular aneurysm repair renal injury aortic aneurysm abdominal endarterectomy carotid endovascular procedures glomerular filtration rate humans |
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