Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Vasc Surg. 2020 Feb;71(2):450-456. doi: 10.1016/j.jvs.2019.03.061. Epub 2019 Jun 24.
Several reports have indicated that suprarenal (SR) fixation may impair renal function after endovascular abdominal aortic aneurysm repair (EVAR). However, most were short-term or at most, 1-year observational studies; therefore, the midterm effects on renal function remain unclear. This study aimed to identify predictors of midterm renal dysfunction after EVAR and compare renal outcomes in patients after EVAR with SR and infrarenal (IR) fixation.
A total of 467 patients who underwent EVAR of nonruptured IR abdominal aortic aneurysm between 2007 and 2014 were reviewed in a prospectively collected database. Patients on hemodialysis at baseline were excluded. Among the remaining patients, those with 3-year laboratory testing were included in this study. Patients who developed acute kidney injury were excluded from the late renal function estimation. Predictors of 3-year renal function decline were estimated using logistic regression analysis. In addition, patients undergoing EVAR with IR (IR group) and SR fixation devices (SR group) were propensity matched by age, sex, baseline renal function, baseline aneurysm diameter, comorbidities, smoking habits, and regular use of medicines that may act on kidney function. Changes in renal function after surgery were compared between the IR group and the SR group.
During the study period, 237 patients (102 IRs and 135 SRs) were followed up with laboratory testing 3 years after surgery. Logistic regression analysis revealed that the use of a SR fixation device was independently predictive of a more than 20% decrease in the estimated glomerular filtration rate at 3 years after EVAR (odds ratio, 2.06; 95% confidence interval, 1.18-3.58; P = .011). Eleven patients who developed acute kidney injury (1 IR and 10 SRs) were excluded from the subsequent analysis. After propensity score matching, 87 pairs were selected (mean age, 77.2 ± 6.3 years; 151 males [86.8%]). The mean follow-up duration was 5.5 ± 1.8 years. In the SR group, estimated glomerular filtration rate at 3 years after surgery decreased significantly more than that in the IR group (mean of 17.8% vs 11.6%, respectively; P = .034).
This study suggests that, compared with EVAR with IR endograft fixation, EVAR with SR endograft fixation is associated with worse outcomes for midterm renal function.
有几项报告表明，血管内腹主动脉瘤修复（EVAR）后肾上腺（SR）固定可能会损害肾功能。然而，大多数都是短期的，最长只有 1 年的观察性研究；因此，肾功能的中期影响仍不清楚。本研究旨在确定 EVAR 后中期肾功能障碍的预测因素，并比较 EVAR 后 SR 和肾下（IR）固定患者的肾脏结局。
回顾了 2007 年至 2014 年间接受非破裂性 IR 腹主动脉瘤 EVAR 的 467 例患者的前瞻性数据库。排除基线时接受血液透析的患者。在剩余的患者中，将接受 3 年实验室检查的患者纳入本研究。排除发生急性肾损伤的患者，以进行晚期肾功能评估。使用逻辑回归分析来估计 3 年肾功能下降的预测因素。此外，通过年龄、性别、基线肾功能、基线动脉瘤直径、合并症、吸烟习惯以及可能影响肾功能的常规用药，对接受 EVAR 治疗的患者进行 IR（IR 组）和 SR 固定装置（SR 组）的倾向评分匹配。比较手术后两组患者的肾功能变化。
在研究期间，对 237 例患者（102 例 IR 和 135 例 SR）进行了实验室检测，术后 3 年随访。逻辑回归分析显示，SR 固定装置的使用是 EVAR 后 3 年估计肾小球滤过率下降超过 20%的独立预测因素（优势比，2.06；95%置信区间，1.18-3.58；P =.011）。随后的分析排除了 11 例发生急性肾损伤的患者（1 例 IR 和 10 例 SR）。进行倾向评分匹配后，选择了 87 对患者（平均年龄，77.2 ± 6.3 岁；男性 151 例[86.8%]）。平均随访时间为 5.5 ± 1.8 年。在 SR 组中，手术后 3 年的估计肾小球滤过率下降明显大于 IR 组（分别为 17.8%和 11.6%；P =.034）。
本研究表明，与 EVAR 联合 IR 内植物固定相比，EVAR 联合 SR 内植物固定与中期肾功能的预后更差相关。
