Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
Cardiovasc Intervent Radiol. 2019 Dec;42(12):1687-1694. doi: 10.1007/s00270-019-02342-2. Epub 2019 Sep 17.
To evaluate the incidence of acute renal failure and chronic kidney disease due to occlusion of accessory renal arteries during endovascular aneurysm repair of infrarenal abdominal aortic aneurysm.
We retrospectively reviewed the course of 181 patients (mean age, 71, SD ± 9 years) who underwent EVAR of infrarenal abdominal aortic aneurysm. The renal vessel anatomy was analyzed in all pre- and postoperative CT scans. Diameter and origin of accessory renal arteries were evaluated. Renal function was determined by pre- and postoperative serum creatinine and eGFR levels. Long-term follow-up (>3 months) of patients was available in 121 cases (66.9%). Acute kidney injury and chronic kidney failure were defined according to guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO).
In 65 of 181 patients (33.9%), 82 accessory renal arteries were identified preoperatively. In 19 of 181 patients (10.5%), one or more accessory renal arteries were covered and subsequently occluded by the implanted stent-graft device. Neither acute kidney injury (10.3% vs 12.5%; p = .785) nor chronic kidney disease (10.7% vs 15.38%; p = .452) was detected significantly more often in patients with covered accessory renal artery. The only significant predictor of acute kidney injury was the preoperative serum creatinine level (1.12 mg/dl vs. 0.98 mg/dl; p = .03). Significant predictors for chronic kidney disease were preoperative serum creatinine, eGFR, and impaired renal function (p < .001).
Coverage of accessory renal artery due to stent-graft does not lead either to temporary acute kidney injury after endovascular aneurysm repair or to chronic kidney disease.
Level II b.
评估肾下腹部主动脉瘤腔内修复术中因副肾动脉闭塞导致急性肾衰竭和慢性肾脏病的发生率。
我们回顾性分析了 181 例（平均年龄 71 岁，标准差±9 岁）接受肾下腹部主动脉瘤腔内修复术患者的病程。所有患者术前和术后 CT 扫描均分析了肾血管解剖结构。评估了副肾动脉的直径和起源。通过术前和术后血清肌酐和 eGFR 水平来确定肾功能。121 例（66.9%）患者可获得长期随访（>3 个月）。根据“肾脏病：改善全球结局”（KDIGO）指南定义急性肾损伤和慢性肾衰竭。
在 181 例患者中，65 例（33.9%）术前发现 82 条副肾动脉。在 181 例患者中，19 例（10.5%）一条或多条副肾动脉被植入的支架移植物覆盖并随后闭塞。被覆盖的副肾动脉患者中，急性肾损伤（10.3%比 12.5%；p=0.785）和慢性肾脏病（10.7%比 15.38%；p=0.452）的发生率均无显著差异。急性肾损伤的唯一显著预测因子是术前血清肌酐水平（1.12mg/dl 比 0.98mg/dl；p=0.03）。慢性肾脏病的显著预测因子是术前血清肌酐、eGFR 和肾功能受损（p<0.001）。
支架移植物覆盖副肾动脉不会导致血管内动脉瘤修复后出现暂时性急性肾损伤，也不会导致慢性肾脏病。
2b 级。
