Zettervall S L, Soden P A, Deery S E, Ultee K, Shean K E, Shuja F, Amdur R L, Schermerhorn M L
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Surgery, George Washington University, Washington, DC, USA.
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Eur J Vasc Endovasc Surg. 2017 Jul;54(1):5-11. doi: 10.1016/j.ejvs.2017.02.001. Epub 2017 Mar 6.
Surgeons have multiple grafts options available for the endovascular treatment of abdominal aortic aneurysm (EVAR), and some hypothesize that suprarenal fixation endografts may result in higher rates of renal complications than infrarenal endografts. This study aimed to compare the outcomes of contemporary suprarenal and infrarenal endografts.
The Targeted Vascular Module of the National Surgical Quality Improvement Project was utilised to identify patients undergoing EVAR for infrarenal aneurysm from 2011 to 2013. Pre-operative and operative variables and 30 day outcomes were compared among suprarenal (Zenith and Endurant) and infrarenal fixation devices (Excluder). Renal complications included creatinine increase > 2 mg/dL or new dialysis, as defined by NSQIP. Multivariate regression was completed to account for patient demographics, comorbidities, and operative characteristics.
A total of 3587 patients were evaluated including 2273 (63%) with suprarenal grafts and 1314 (37%) with infrarenal grafts. Patients with suprarenal grafts were less commonly white (84% vs. 88%, p < .01) and more commonly male (83% vs. 80%, p = .03). There were no differences in age or comorbidities. Renal complications (1.1% vs. 0.1%, p < .01) and length of stay more than 2 days (34% vs. 25%, p < .01) occurred more commonly after suprarenal fixation. After adjustment, suprarenal grafts had significantly higher rates of renal complications (OR, 12.0; 95% CI, 1.6-91) and length of stay more than 2 days (OR, 1.4; 95% CI, 1.2-1.7).
Overall rates of renal complications following EVAR are low. Patients selected for suprarenal stent grafts are at increased risk of renal complications and prolonged length of stay, which may be due to selection bias, deployment techniques, or the presence of a bare stent overlying the renal arteries. Further studies are necessary to evaluate the mechanism and duration of renal dysfunction and important long-term outcomes of interest.
外科医生在腹主动脉瘤腔内修复术（EVAR）中有多种移植物可供选择，一些人推测肾上固定型腔内移植物可能比肾下型腔内移植物导致更高的肾脏并发症发生率。本研究旨在比较当代肾上型和肾下型腔内移植物的治疗效果。
利用国家外科质量改进项目的靶向血管模块，确定2011年至2013年因肾下动脉瘤接受EVAR治疗的患者。比较肾上型（Zenith和Endurant）和肾下固定装置（Excluder）的术前和手术变量以及30天的治疗结果。肾脏并发症包括肌酐升高>2mg/dL或新的透析，这是根据NSQIP定义的。完成多因素回归以考虑患者的人口统计学、合并症和手术特征。
共评估了3587例患者，其中2273例（63%）使用肾上型移植物，1314例（37%）使用肾下型移植物。使用肾上型移植物的患者白人比例较低（84%对88%，p<.01），男性比例较高（83%对80%，p=.03）。年龄和合并症方面无差异。肾上固定术后肾脏并发症（1.1%对0.1%，p<.01）和住院时间超过2天（34%对25%，p<.01）更为常见。调整后，肾上型移植物的肾脏并发症发生率显著更高（OR，12.0；95%CI，1.6 - 91），住院时间超过2天的发生率也更高（OR，1.4；95%CI，1.2 - 1.7）。结论：EVAR术后总体肾脏并发症发生率较低。选择肾上型支架移植物的患者发生肾脏并发症和住院时间延长的风险增加，这可能是由于选择偏倚、植入技术或肾动脉上方存在裸支架所致。有必要进一步研究以评估肾功能障碍的机制和持续时间以及重要的长期关注结果。
