Geragotellis Alexander, Cox Kofi, Yip Ho Cheung Anthony, Jubouri Matti, Williams Ian M, Bailey Damian M, Bashir Mohamad
Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
St. George's University of London, London, UK.
Cardiovasc Diagn Ther. 2022 Aug;12(4):531-544. doi: 10.21037/cdt-22-196.
Abdominal aortic aneurysm (AAA) is a common pathology with a prevalence of 4.8%. AAA rupture is associated with significant mortality and so early diagnosis followed by regular monitoring is needed until treatment might be considered and plan intervention. Endovascular aneurysm repair (EVAR) is an established and effective alternative to open surgical repair (OSR) in the treatment of AAAs. Key parameters in defining conventional EVAR suitability include the infrarenal neck length and angulation for the fixation of the proximal graft component. Endograft fixation can be either suprarenal or infrarenal and much debate exists as to which approach is associated with optimum renal outcomes. This study aims to review the current literature with respect to the renal outcomes associated with conventional EVAR using suprarenal fixation (SRF) infrarenal fixation (IRF).
A search was conducted from major search indices (PubMed, Google Scholar and EMBASE) to identify relevant literature pertaining to renal outcomes in EVAR. Recent papers comparing SRF and IRF were evaluated and their findings discussed.
The mechanism of renal function decline (RFD) following EVAR is uncertain and likely multifactorial. Aortic morphology, endograft type and surgical technique may all contribute to RFD. There is a significant degree of heterogeneity within the literature regarding study design and definitions of RFD. Recent literature suggests that RFD is more acute for SRF than IRF in the first post-operative year, but the clinical significance of this decline in patients with normal kidney function is questionable. Studies indicate that SRF is associated with accelerated RFD at 5 years, and that the RFD is worse in patients who are female and who have pre-existing renal insufficiency.
SRF is associated with a greater decline in renal function than IRF in both short- and long-terms. Although clinically insignificant in the short-term, the limited available long-term evidence suggests that SRF results in a relatively accelerated decline in renal function when compared to IRF, but it is possibly partially explained by the higher prevalence of advanced degenerative/atherosclerotic disease in SRF cohorts. These trends are noted particularly in female patients and in patients with baseline renal insufficiency.
腹主动脉瘤（AAA）是一种常见病症，患病率为4.8%。AAA破裂与显著的死亡率相关，因此需要早期诊断并进行定期监测，直至考虑治疗并规划干预措施。在腹主动脉瘤的治疗中，血管腔内修复术（EVAR）是一种成熟且有效的开放手术修复（OSR）替代方案。定义传统EVAR适用性的关键参数包括肾下颈部长度以及近端移植物组件固定的角度。内支架固定可分为肾上固定或肾下固定，关于哪种方法与最佳肾脏结局相关存在诸多争议。本研究旨在回顾当前关于使用肾上固定（SRF）和肾下固定（IRF）的传统EVAR相关肾脏结局的文献。
从主要检索索引（PubMed、谷歌学术和EMBASE）进行检索，以识别与EVAR肾脏结局相关的相关文献。对近期比较SRF和IRF的论文进行评估并讨论其结果。
EVAR后肾功能下降（RFD）的机制尚不确定，可能是多因素的。主动脉形态、内支架类型和手术技术都可能导致RFD。关于研究设计和RFD定义，文献中存在显著程度的异质性。近期文献表明，在术后第一年，SRF导致的RFD比IRF更急剧，但这种肾功能下降对肾功能正常患者的临床意义值得怀疑。研究表明，SRF在5年时与加速的RFD相关，并且在女性患者和已有肾功能不全的患者中RFD更严重。
短期和长期来看，SRF与比IRF更大的肾功能下降相关。虽然短期内临床意义不大，但有限的现有长期证据表明，与IRF相比，SRF导致肾功能相对加速下降，但这可能部分由SRF队列中晚期退行性/动脉粥样硬化疾病的较高患病率所解释。这些趋势在女性患者和基线肾功能不全患者中尤为明显。
