Service de Chirurgie Vasculaire et Endovasculaire, CHU Besançon, Besançon, France; EA3920, UFR Santé, Université de Bourgogne-Franche-Comte, Besançon, France.
Service de Chirurgie Vasculaire et Endovasculaire, CHU Besançon, Besançon, France.
Ann Vasc Surg. 2021 Feb;71:402-410. doi: 10.1016/j.avsg.2020.07.053. Epub 2020 Aug 12.
Long-term outcomes of accessory renal artery (ARA) coverage after endovascular aneurysm repair (EVAR) are unknown. We analyzed the impact of ARA coverage on renal function long-term.
This retrospective, monocentric study included patients treated by EVAR between 2008 and 2016. Patients with at least one ARA covered with EVAR (ARA group) were compared with patients with no covered ARA (control group). Renal function was determined by estimating the glomerular filtration rate (eGFR) and graded according to chronic kidney disease (CKD) classification stages.
A total of 184 patients were included (ARA group, n = 25; control group, n = 159). Renal risk factors were similar in the 2 groups. Mean (±standard deviation) duration of follow-up was 41.6 ± 25.8 months. Preoperative eGFR (mL/min/1.73 m) was 68.9 ± 17.8 in the ARA group and 72.5 ± 17.4 in the control group (P = 0.33), with a similar decline in the 2 groups during follow-up (-6.52 ± 11.6 ARA group vs. -6.43 ± 13.8 control group; P = 0.97). At the end of the study, 8 ARA patients and 56 controls had deteriorated by one CKD stage (32% vs. 35.2%, respectively; P = 0.75). Rate of renal infarction was significantly higher in the ARA group (96% vs. 1.9%; P < 0.0001). In multivariate analysis, suprarenal fixation was identified as a risk factor for a decline in renal function (odds ratio = 2.01 [95% confidence interval: 1.05-3.84]; P = 0.04).
ARA coverage after EVAR does not appear to affect renal function long-term. Suprarenal fixation led to a greater decline in renal function.
血管内动脉瘤修复术 (EVAR) 后副肾动脉 (ARA) 覆盖的长期结果尚不清楚。我们分析了 ARA 覆盖对长期肾功能的影响。
本回顾性单中心研究纳入了 2008 年至 2016 年接受 EVAR 治疗的患者。接受 EVAR 治疗的患者至少有一条 ARA 被覆盖（ARA 组），与未覆盖 ARA 的患者（对照组）进行比较。通过估计肾小球滤过率（eGFR）来确定肾功能，并根据慢性肾脏病（CKD）分类阶段进行分级。
共纳入 184 例患者（ARA 组，n=25；对照组，n=159）。两组患者的肾脏危险因素相似。两组的中位（±标准差）随访时间分别为 41.6±25.8 个月。ARA 组术前 eGFR（mL/min/1.73 m）为 68.9±17.8，对照组为 72.5±17.4（P=0.33），两组在随访期间均有相似的下降（-6.52±11.6 ARA 组 vs. -6.43±13.8 对照组；P=0.97）。研究结束时，8 例 ARA 患者和 56 例对照组患者的 CKD 分期恶化了 1 期（分别为 32%和 35.2%；P=0.75）。ARA 组的肾梗死发生率明显更高（96% vs. 1.9%；P<0.0001）。多变量分析显示，肾上固定是肾功能下降的危险因素（比值比=2.01 [95%置信区间：1.05-3.84]；P=0.04）。
EVAR 后 ARA 覆盖似乎不会对长期肾功能产生影响。肾上固定导致肾功能下降更明显。
