Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Greece.
J Endovasc Ther. 2013 Jun;20(3):334-44. doi: 10.1583/12-4177MR.1.
To report a prospective nonrandomized study comparing the effects of suprarenal (SR) vs. infrarenal (IR) stent-graft fixation on renal function in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).
Patients with AAA undergoing elective EVAR between June 2008 and June 2010 were eligible for the comparative study of fixation method on renal function. Patients with impaired renal function [estimated creatinine clearance (eCrCl) <30 mL/min] or a history of renal impairment were not eligible. Renal function was assessed by measuring serum creatinine (SCr) and total proteins and microalbumin in the urine preoperatively, on postoperative day 1, and at 1, 6, and 12 months. The eCrCl was calculated using the Cockcroft-Gault formula. A standard preoperative hydration protocol was followed in all patients, and stent-graft choice was at the operator's discretion. Of 116 patients undergoing elective EVAR in the study period, 16 were ineligible, leaving 100 patients (95 men; median age 74 years) enrolled in the study (49 SR and 51 IR).
There was no statistically significant difference between the groups in the prevalence of any risk factor, the baseline SCr and eCrCl values, contrast usage, or procedure duration. At the postoperative measurement, there was no significant deterioration of renal function in either group, although total urinary proteins increased significantly in both groups (IR p=0.01, SR p<0.001). At the 12-month follow-up, patients in the IR group had no significant alteration in any marker vs. baseline, while patients in the SR group had significant alterations in SCr (p=0.001), eCrCl (p<0.001), and microalbumin (p=0.04) in urine. The number of patients with a >20% decrease in eCrCl was not significantly different between the groups. No patient had an adverse renal event.
Deterioration in renal function was observed 12 months after EVAR in patients receiving a stent-graft with suprarenal fixation, even though this did not seem to increase the likelihood of postoperative renal impairment. Furthermore, suprarenal fixation may be responsible for progressively significant proteinuria. Further studies are needed to determine the long-term impact of suprarenal fixation on renal function and investigate the potential risk of progressive renal disease in relation to type of fixation.
报告一项前瞻性非随机研究，比较肾上（SR）和肾下（IR）支架固定对接受腹主动脉瘤（AAA）血管内修复（EVAR）的患者肾功能的影响。
2008 年 6 月至 2010 年 6 月期间接受择期 EVAR 的 AAA 患者有资格参加支架固定方法对肾功能的比较研究。不适合肾功能受损[估计肌酐清除率（eCrCl）<30ml/min]或有肾功能受损史的患者不适合。术前、术后第 1 天、术后 1、6 和 12 个月时通过测量血清肌酐（SCr）和尿液中的总蛋白和微量白蛋白来评估肾功能。eCrCl 使用 Cockcroft-Gault 公式计算。所有患者均遵循标准的术前水化方案，支架选择由术者决定。在研究期间，有 116 名患者接受了择期 EVAR，其中 16 名患者不适合，共有 100 名患者（95 名男性；中位年龄 74 岁）入组（49 名 SR 和 51 名 IR）。
两组在任何危险因素的患病率、基线 SCr 和 eCrCl 值、造影剂使用量或手术时间方面均无统计学差异。在术后测量时，两组肾功能均无明显恶化，尽管两组的总尿蛋白均显著增加（IR p=0.01，SR p<0.001）。在 12 个月的随访中，IR 组患者的任何标志物与基线相比均无明显变化，而 SR 组患者的 SCr（p=0.001）、eCrCl（p<0.001）和尿微量白蛋白（p=0.04）均有显著变化。两组患者 eCrCl 下降>20%的人数无显著差异。无患者发生不良肾脏事件。
即使这似乎并没有增加术后肾功能损害的可能性，接受肾上支架固定的患者在 EVAR 后 12 个月时肾功能仍有恶化，并且这与支架固定的类型有关。此外，肾上固定可能与进行性显著蛋白尿有关。需要进一步的研究来确定肾上固定对肾功能的长期影响，并研究与固定类型相关的进行性肾病的潜在风险。
