Lareyre Fabien, Raffort Juliette, Carboni Joseph, Chikande Julien, Massiot Nicolas, Voury-Pons Audrey, Umbdenstock Emilien, Hassen-Khodja Réda, Jean-Baptiste Elixène
Department of Vascular Surgery, University Hospital of Nice, Nice, France; Université Côte d'Azur, CHU, Inserm, C3M, Nice, France.
Université Côte d'Azur, CHU, Inserm, C3M, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France.
Ann Vasc Surg. 2019 Jul;58:45-53.e1. doi: 10.1016/j.avsg.2018.10.040. Epub 2019 Feb 7.
Fenestrated endovascular aortic repair (FEVAR) of complex aneurysm can require the coverage of polar renal artery. The aim of this study was to investigate the impact of the procedure on postoperative outcomes in patients with juxtarenal or thoracoabdominal aortic aneurysms.
Patients who had FEVAR for juxtarenal or type IV thoracoabdominal aortic aneurysm were retrospectively included between January 2010 and October 2017. The estimated glomerular filtration rate (eGFR) was recorded before and at 1 day, 7 days after surgery, and at the last follow-up. The occurrence of renal infarct was analyzed on the injected computed tomography scan images.
Forty-three patients deemed at high-risk for open repair underwent FEVAR; 10 patients (23.3%) had polar renal artery coverage and were compared to patients without polar renal artery. The eGFR did not differ between the groups at 1 day and 7 days after FEVAR (69 vs 61.6 mL/mn/1.73 m, P = 0.8708 and 68.4 mL/mn/1.73 m vs 68, P = 0.9440, respectively). For a median follow-up of 233 days, the eGFR at the latest follow-up was 38 mL/mn/1.73 m (21.8-56.3) in patients who had polar renal artery covered and 57 mL/mn/1.73 m (46.5-76) in patients without polar renal artery (P = 0.0748). Patients who had polar renal artery had a higher rate of postoperative kidney renal infarct (60% vs 21.2%, P = 0.0441). The proportion of vascular complications did not differ (30% vs 30.3%, P = 0.9999). No endoleak related to polar renal artery coverage was observed. The 30-day postoperative mortality was 4.7%.
Polar renal artery coverage during FEVAR is not associated with critical renal and vascular short-term outcomes but could impact long-term renal function.
复杂动脉瘤的开窗式血管内主动脉修复术（FEVAR）可能需要覆盖肾动脉极。本研究旨在探讨该手术对近肾或胸腹主动脉瘤患者术后结局的影响。
回顾性纳入2010年1月至2017年10月期间接受FEVAR治疗近肾或IV型胸腹主动脉瘤的患者。记录术前、术后1天、7天及末次随访时的估计肾小球滤过率（eGFR）。在注入式计算机断层扫描图像上分析肾梗死的发生情况。
43例被认为开放修复高危的患者接受了FEVAR；10例（23.3%）患者肾动脉极被覆盖，并与未覆盖肾动脉极的患者进行比较。FEVAR术后1天和7天时，两组的eGFR无差异（分别为69 vs 61.6 mL/mn/1.73 m²，P = 0.8708；68.4 mL/mn/1.73 m² vs 68，P = 0.9440）。中位随访233天，肾动脉极被覆盖的患者末次随访时的eGFR为38 mL/mn/1.73 m²（21.8 - 56.3），未覆盖肾动脉极的患者为57 mL/mn/1.73 m²（46.5 - 76）（P = 0.0748）。肾动脉极被覆盖的患者术后肾梗死发生率更高（60% vs 21.2%，P = 0.0441）。血管并发症的比例无差异（30% vs 30.3%，P = 0.9999）。未观察到与肾动脉极覆盖相关的内漏。术后30天死亡率为4.7%。
FEVAR期间肾动脉极覆盖与严重的肾脏和血管短期结局无关，但可能影响长期肾功能。
