Sadeghi-Azandaryani Mojtaba, Zimmermann Hanna, Korten Insa, Klose Alexander, Scheiermann Patrick, Treitl Marcus, Heyn Jens
Department of Vascular Surgery, Erding Hospital, Erding, Germany; Department of Surgery, University of Munich (LMU), Munich, Germany.
Department of Radiology, University of Munich (LMU), Munich, Germany.
J Vasc Surg. 2017 Mar;65(3):635-642. doi: 10.1016/j.jvs.2016.06.116. Epub 2016 Oct 28.
Coverage of an accessory renal artery (ARA) during endovascular aneurysm repair (EVAR) may result in renal infarction (RI) or decline in renal function. Until now, it remains vague which patients are at risk to develop these complications. We therefore analyzed the effect of ARA sealing by EVAR with respect to the occurrence of RI and renal function.
A retrospective analysis of the medical records and computed tomographic scans of patients who underwent EVAR within a period of 5 years was performed. Particular attention was paid to the presence or absence of accessory renal arteries and renal function before EVAR. Thirty-four patients with ARA were matched 1:3 to 102 patients without ARA. The results after EVAR were analyzed in patients with and without ARA. In patients with ARA, we further examined the results after EVAR in patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min and eGFR < 60 mL/min before EVAR.
Before EVAR, the median eGFR was 74 mL/min (25th/75th percentiles, 57/89) in patients with ARA and 72 mL/min (25th/75th percentiles, 63/87) in patients without ARA. Alterations in eGFR were significantly pronounced in patients with ARA when compared with patients without ARA 1 week after EVAR (ARA, -10.7 ± 16.9 mL/min vs without ARA, 1.2 ± 13.3 mL/min; P = .002) and after 6 months (ARA, -10.8 ± 17.4 mL/min vs without ARA, 1.2 ± 13.3 mL/min; P = .001). RI only occurred in patients with ARA. Within the group of patients with ARA, patients with normal renal function (NF) showed a more pronounced decline in eGFR preoperatively when compared with patients with impaired renal function (IF) 1 week after EVAR (NF, -14.3 ± 18.0 mL/min vs IF, -1.3 ± 10.8 mL/min; P = .02) and after 6 months (NF, -15.8 ± 17.9 mL/min vs IF, 0.1 ± 15.2 mL/min; P = .007).
The decrease in renal function was more pronounced in patients with ARA after EVAR when compared with patients without ARA undergoing EVAR. In patients with ARA, the observed decline in renal function was significantly distinct in patients presenting NF preoperatively. Consequently, the risk of IF after EVAR seems to be increased in patients with ARA and normal preoperative renal function.
血管内动脉瘤修复术（EVAR）期间对副肾动脉（ARA）的覆盖可能导致肾梗死（RI）或肾功能下降。迄今为止，哪些患者有发生这些并发症的风险仍不明确。因此，我们分析了EVAR封堵ARA对RI发生情况及肾功能的影响。
对5年内接受EVAR的患者的病历和计算机断层扫描进行回顾性分析。特别关注EVAR术前副肾动脉的有无及肾功能情况。34例有ARA的患者与102例无ARA的患者按1:3进行匹配。对有和无ARA的患者EVAR后的结果进行分析。在有ARA的患者中，我们进一步检查了EVAR术前估计肾小球滤过率（eGFR）≥60 mL/min和eGFR < 60 mL/min的患者EVAR后的结果。
EVAR术前，有ARA的患者中位eGFR为74 mL/min（第25/75百分位数，57/89），无ARA的患者为72 mL/min（第25/75百分位数，63/87）。与无ARA的患者相比，有ARA的患者在EVAR后1周（有ARA，-10.7±16.9 mL/min vs无ARA，1.2±13.3 mL/min；P = .002）和6个月后（有ARA，-10.8±17.4 mL/min vs无ARA，1.2±13.3 mL/min；P = .001）eGFR的变化更为明显。RI仅发生在有ARA的患者中。在有ARA的患者组中，术前肾功能正常（NF）的患者与肾功能受损（IF）的患者相比，在EVAR后1周（NF，-14.3±18.0 mL/min vs IF，-1.3±10.8 mL/min；P = .02）和6个月后（NF，-15.8±17.9 mL/min vs IF，0.1±15.2 mL/min；P = .007）eGFR下降更为明显。
与接受EVAR的无ARA患者相比，接受EVAR的有ARA患者肾功能下降更为明显。在有ARA的患者中，术前表现为NF的患者观察到的肾功能下降明显不同。因此，术前肾功能正常的有ARA患者EVAR后发生IF的风险似乎增加。
