Directorate of Research and Development, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, United Kingdom.
J Vasc Surg. 2012 Sep;56(3):594-600. doi: 10.1016/j.jvs.2012.01.078. Epub 2012 May 11.
Suprarenal endograft fixation is routinely used in the endovascular repair of abdominal aortic aneurysms (EVAR) to enhance proximal endograft attachment but can be associated with an adverse outcome in renal function. This prospective study assessed the effect of suprarenal fixation on serum creatinine concentration and estimated glomerular filtration rate (eGFR), calculated by the Modified Diet in Renal Disease equation, 12 months after elective EVAR.
Patients undergoing elective EVAR were divided into suprarenal vs infrarenal fixation groups matched for age, sex, smoking, and aneurysm diameter. Serum creatinine and eGFR were measured at baseline, 6, and 12 months.
Included were 92 patients (two women) with a mean age of 71 ± 7 years, with 46 in each group. No device-related complications were noted. Serum creatinine did not differ significantly between groups at 6 (P = .24) or 12 (P = .08) months but significantly increased in the suprarenal group at 12 months (1.08 ± 0.36 to 1.16 ± 0.36 mg/dL; P < .001) vs baseline. The eGFR (mL/min/1.73 m(2)) did not differ significantly at baseline between the suprarenal (85 ± 27) and infrarenal (80 ± 28; P = .33) groups or at 6 months (88 ± 29 vs 77 ± 24, respectively; P = .07). At 12 months, the suprarenal group had a lower eGFR (73 ± 23) than the infrarenal group (84 ± 26; P = .027). The eGFR at 12 months showed a significant decrease in the suprarenal (80 ± 28 to 73 ± 23; P < .001) but not in the infrarenal group (85 ± 27 to 84 ± 26; P = .48). The drop in eGFR differed significantly at 12 months in the infrarenal vs the suprarenal (0.82 vs -6.94; P < .001) group. No patient progressed to end-stage renal disease or disclosed a drop in eGFR > 30%.
In contrast to previous studies, this study suggests that suprarenal endograft fixation in elective EVAR is associated with a drop in eGFR at 12 months.
在腹主动脉瘤的血管内修复（EVAR）中，常规使用肾上固定来增强近端移植物的附着，但可能对肾功能产生不良后果。这项前瞻性研究评估了肾上固定对选择性 EVAR 后 12 个月血清肌酐浓度和经改良肾脏病饮食方程（MDRD 方程）计算的估计肾小球滤过率（eGFR）的影响。
将接受选择性 EVAR 的患者分为肾上固定组和肾下固定组，两组按年龄、性别、吸烟和动脉瘤直径匹配。在基线、6 个月和 12 个月时测量血清肌酐和 eGFR。
纳入 92 名患者（2 名女性），平均年龄为 71±7 岁，每组 46 名。未发现与器械相关的并发症。在 6 个月（P=0.24）或 12 个月（P=0.08）时，两组间的血清肌酐无显著差异，但肾上固定组在 12 个月时显著升高（1.08±0.36 至 1.16±0.36mg/dL；P<0.001）。在基线时，肾上固定组（85±27）和肾下固定组（80±28；P=0.33）之间的 eGFR（mL/min/1.73m2）无显著差异，6 个月时也无显著差异（分别为 88±29 与 77±24；P=0.07）。12 个月时，肾上固定组的 eGFR （73±23）低于肾下固定组（84±26；P=0.027）。在肾上固定组中，eGFR 在 12 个月时显著下降（80±28 至 73±23；P<0.001），但在肾下固定组中没有下降（85±27 至 84±26；P=0.48）。12 个月时，肾下固定组与肾上固定组的 eGFR 下降有显著差异（0.82 与-6.94；P<0.001）。没有患者进展为终末期肾病或出现 eGFR 下降>30%。
与之前的研究相比，本研究表明，选择性 EVAR 中的肾上固定与 12 个月时 eGFR 的下降有关。
