M. M. Oberdoerster1, M. M. Wynn1, P. D. DiMusto1 1University Of Wisconsin,Madison, WI, USA
Introduction: Fenestrated endovascular abdominal aortic aneurysm repair (fEVAR) has been approved for clinical use since 2012. One possible complication of this repair is impairment in renal function. We sought to assess the clinical outcomes related to renal function over time in patients undergoing fEVAR at our tertiary referral center.
Methods: A retrospective review was conducted of prospectively collected data on all patients undergoing fEVAR at our institution between 2012 and 2017. Patient characteristics, procedural variables, laboratory values, and imaging characteristics were collected. Serum creatinine was measured preoperatively, and at 1 month, 6 months, 1 year and yearly thereafter. Estimated glomerular filtration rate was calculated using the Cockcroft Gault equation.
Results: A total of 58 patients were included: 42 men and 16 women with an average age of 75 years. The average follow up time was 469 days; 6 patients were lost to follow up. A total of 111 out of 116 main renal arteries were successfully revascularized. Only one main renal artery that was planned for revascularization was not due to the inability to place a stent intraoperatively. The other four were above the graft and did not require revascularization. There were 11 accessory renal arteries that were covered with the aortic graft.
Eighteen patients (31%) had advanced chronic kidney disease (CKD) prior to the repair; 17 stage III, 1 stage IV. Nine patients (15.5%), including 3 of the 18 who had CKD prior to the repair, had an increase of at least 30% from baseline creatinine over two or more follow up visits. All nine had evidence of post-operative renal insult including infarct, renal artery stenosis, or occlusion. Four patients (7%) with no prior history of CKD progressed to stage II, 13 (22%) patients progressed from stage II to III, and 3 patients (5%) progressed from stage III to stage IV over the follow up period. Only the patient with stage IV CKD at the time of the repair went on to require dialysis 8 months after his procedure.
Eight patients (13.7%) developed stenosis in one of the renal artery stents. Five of these patients had worsening of their renal function with progression by one CKD stage. Two patients had an intervention due to the stenosis, but only one was successful. Four additional patients developed a renal artery occlusion, three of which had a progression of CKD by one stage. None of these patients went on to dialysis. A total of 24 patients (41%) developed renal infarction on imaging over the follow up period. Nine of these patients had progression of their CKD stage, however none went on to dialysis.
Conclusion: Our review demonstrates that while kidney dysfunction can occur over the long term following fEVAR, rates of worsening renal function are relatively low. Additionally, in patients with pre-operative CKD, fEVAR remains safe and effective with low rates of progression to dialysis.