C. I. Aghaie1, L. E. Trakimas1, D. S. Mix1, K. Rasheed1, M. Seaman1, J. L. Ellis1, R. J. Glocker1, A. J. Doyle1, M. C. Stoner1 1University Of Rochester,Vascular Surgery,Rochester, NY, USA
Introduction:
Anatomic Severity Grade (ASG) represents a quantitative mechanism for assessing anatomical suitability for endovascular aortic repair. ASG has been correlated with perioperative and mid-term outcomes, and resource utilization. The purpose of this study was to identify the correlation of a novel renal perfusion metric and ASG.
Methods:
Elective infrarenal aortic repair cases were identified in a retrospective database, describing patient operative and anatomical factors. Anatomic grading was undertaken by independent reviewers. Using volumetric software, kidney volume and a novel measure of kidney functional volume – radiographic kidney volume perfusion (RKVP) – was recorded. Systematic evaluation of the relationship of kidney volume and RKVP to CKD (glomerular filtration rate (GFR) < 60 ml/min) and ASG was undertaken using linear regression and receiver-operator statistical tools.
Results:
A total of 386 cases with patient and anatomic data were identified and graded. Mean age was 72.9 ± 0.4 years. Renal volume < 281 mL was correlated with CKD (AUC = 0.708, p = <0.0001). RKVP < 22.5 HU*L was correlated with CKD (AUC = 0.764, p = <0.0001). High (≥15) ASG scores correlated with both renal volume (AUC = 0.628, p = < 0.0001) and RKVP (AUC = 0.628, p = < 0.0001). Regression analysis demonstrated a strong, inverse relationship between ASG and RKVP (Figure).
Conclusion:
These data demonstrate that the novel metric of RKVP correlates with both CKD and ASG in a large database of patients undergoing elective aneurysm repair. The inverse relationship between renal function (renal volume, RKVP or GFR) and ASG has not been described in the literature before. Outcomes in patients with poor renal function may be related to anatomical issues in addition to well-described systemic ramifications.
