Vascular Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile; German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Vasc Surg. 2022 Sep;76(3):656-662. doi: 10.1016/j.jvs.2022.02.039. Epub 2022 Mar 8.
The objective of this study was to evaluate renal function and renal parenchymal length changes secondary to the coverage or preservation of accessory renal arteries (ARAs) in complex aortic repair.
This was a single-center retrospective study identifying all patients undergoing fenestrated or branched endovascular aortic repair (f-b EVAR) who presented with ARAs. Two groups were created, a preserved ARA group, with incorporation of the vessel as a dedicated fenestration or branch in the endograft plan, and a non-preserved ARA group, without incorporation of them. Early >30% decline of glomerular filtration rate (GFR), kidney infarcts, and endoleaks were evaluated. Mid-term results with freedom from kidney shrinkage (defined as length decrease >10%) at follow-up, freedom from GFR decrease >30%, or need for postoperative dialysis at follow-up were also analyzed. Primary assisted patency of incorporated ARAs was calculated.
From 2011 through 2020, 145 patients undergoing complex aortic repair presented with an ARA. After excluding ruptured aneurysms, 33 patients had the ARA preserved with their incorporation into the stent graft (preserved ARA group), and 99 did not have preservation of them (not-preserved ARA group). There were no statistical differences in demographics or type of aneurysm. Patients in the ARA-preserved group had more ARAs (median of two per patient vs one in the non-preserved ARA group; P = .01) and bigger ARAs (median 4 vs 3 mm in the non-preserved ARA group; P = .001). Early postoperative worsening >30% of GFR (23% vs 6%; P = .03) as well as postoperative renal infarction (57% vs 6%; P = .001) and ARA-related endoleaks (20% vs 0%; P = .01) were statistically higher for the not-preserved ARA group. Mid-term kidney length showed significant shrinkage in the not-preserved ARA group compared with the ARA preserved group (9.7% vs 0%; P = .001). Freedom from >30% GFR decline at 2 years was significantly higher for the preserved ARA group (83% vs 47%; P = .01).Two-year primary assisted patency of incorporated ARA was 94%.
Complex aortic repair incorporation of ARA is feasible, with low complications and good primary assisted patency at 2 years. It leads to less postoperative early renal dysfunction as well as higher freedom for mid-term renal disfunction and kidney shrinkage.
本研究旨在评估复杂主动脉修复中覆盖或保留副肾动脉（ARAs）对肾功能和肾实质长度变化的影响。
这是一项单中心回顾性研究，纳入所有接受开窗或分支腔内主动脉修复（f-b EVAR）并存在 ARAs 的患者。将患者分为两组，一组为保留 ARAs 组，将血管作为专用开窗或分支纳入移植物计划；另一组为不保留 ARAs 组，不纳入 ARAs。评估术后 30%以上肾小球滤过率（GFR）下降、肾脏梗死和内漏等早期并发症。分析中期结果，包括随访时肾萎缩（定义为长度减少>10%）、GFR 下降>30%或需要术后透析的发生率。同时还分析了纳入 ARAs 的 2 年辅助通畅率。
2011 年至 2020 年，145 例接受复杂主动脉修复的患者存在 ARAs。排除破裂性动脉瘤后，33 例患者的 ARAs 被保留并纳入支架移植物（保留 ARAs 组），99 例患者的 ARAs 未被保留（未保留 ARAs 组）。两组患者的人口统计学特征或动脉瘤类型无统计学差异。ARAs 保留组患者的 ARAs 更多（中位数为每例 2 支 vs 未保留 ARAs 组的 1 支；P=0.01），ARAs 更大（中位数为 4mm vs 未保留 ARAs 组的 3mm；P=0.001）。术后早期 GFR 恶化>30%（23% vs 6%；P=0.03）、术后肾梗死（57% vs 6%；P=0.001）和与 ARAs 相关的内漏（20% vs 0%；P=0.01）发生率在未保留 ARAs 组更高。中期随访时，未保留 ARAs 组的肾脏长度明显缩小（9.7% vs 0%；P=0.001）。2 年时，保留 ARAs 组的 GFR 下降>30%的发生率显著高于未保留 ARAs 组（83% vs 47%；P=0.01）。2 年时，纳入 ARAs 的 2 年辅助通畅率为 94%。
复杂主动脉修复中 ARAs 的纳入是可行的，并发症发生率低，2 年时的初始辅助通畅率高。它可减少术后早期肾功能障碍，中期肾功能障碍和肾萎缩的发生率更高。
