Lareyre Fabien, Panthier Frédéric, Jean-Baptiste Elixène, Hassen-Khodja Réda, Raffort Juliette
1 Department of Vascular Surgery, University Hospital of Nice, Nice, France.
2 Department of Clinical Biochemistry, University of Côte d'Azur, Inserm, C3M, France.
Angiology. 2019 Jan;70(1):12-19. doi: 10.1177/0003319718771249. Epub 2018 Apr 22.
An accessory renal artery (ARA) represents an anatomic variation which can challenge endovascular aortic aneurysm repair (EVAR). The aim of this review was to summarize the current knowledge on postoperative outcomes following ARA coverage during EVAR. We performed a systematic literature review. The MEDLINE database was searched on September 2017, and 8 relevant studies were included. The frequency of ARA in patients undergoing EVAR varied between 9.5% and 16.2%, and the frequency of ARA coverage varied between 5.2% and 9.4%. Four reports did not observe any significant changes on postoperative renal function, whereas 1 study reported an early transient increase in creatinine after ARA coverage. The occurrence of renal infarct varied from 20% to 84%. Five studies did not observe endoleaks related to ARA coverage, whereas one reported the occurrence of type II endoleaks in 3 of 18 patients who had ARA coverage. No significant change in blood pressure, mortality, and mean length of hospital stay was observed. The ARA coverage can potentially have renal and vascular consequences, but none of them were critical. Further studies may be useful to identify preoperative criteria that may help to choose the most appropriate surgical approach before ARA coverage.
副肾动脉（ARA）是一种解剖变异，可能给血管腔内主动脉瘤修复术（EVAR）带来挑战。本综述的目的是总结当前关于EVAR期间ARA覆盖术后结局的知识。我们进行了一项系统的文献综述。2017年9月检索了MEDLINE数据库，纳入了8项相关研究。接受EVAR的患者中ARA的发生率在9.5%至16.2%之间，ARA覆盖的发生率在5.2%至9.4%之间。4份报告未观察到术后肾功能有任何显著变化，而1项研究报告在ARA覆盖后肌酐早期短暂升高。肾梗死的发生率在20%至84%之间。5项研究未观察到与ARA覆盖相关的内漏，而1项研究报告在18例接受ARA覆盖的患者中有3例发生II型内漏。未观察到血压、死亡率和平均住院时间有显著变化。ARA覆盖可能会对肾脏和血管产生影响，但均不严重。进一步的研究可能有助于确定术前标准，这可能有助于在ARA覆盖前选择最合适的手术方法。
