Proximal fixation of endovascular aortic device may not be associated with renal function decline after abdominal aortic aneurysm repair
| Autor: | Randall R. De Martino, Andrew J. Meltzer, Manju Kalra, Young Erben, Warner A. Oldenburg, Albert G. Hakaim, Thomas C. Bower, Richard J. Fowl, Osman S. Hamid, Camila Franco-Mesa, William M. Stone, Gustavo S. Oderich, Yupeng Li, Michael A Mao, Houssam Farres, Peter Gloviczki, Joao A. Da Rocha-Franco |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Length of hospitalization Renal function 030204 cardiovascular system & hematology Kidney Prosthesis Design Risk Assessment Blood Vessel Prosthesis Implantation 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Primary outcome Risk Factors Humans Medicine 030212 general & internal medicine Aged Retrospective Studies Fixation (histology) Aged 80 and over Creatinine Retrospective review business.industry Endovascular Procedures Length of Stay medicine.disease United States Abdominal aortic aneurysm Blood Vessel Prosthesis Surgery Treatment Outcome chemistry Disease Progression Female Kidney Diseases Hemodialysis Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal Glomerular Filtration Rate |
| Zdroj: | Journal of Vascular Surgery. 74:1861-1866.e1 |
| ISSN: | 0741-5214 |
| Popis: | Significant debate exists among providers who perform endovascular abdominal aortic aneurysm repair (EVAR) regarding the renal function change between suprarenal (SuF) and infrarenal (InF) fixation devices. The purpose of this study is to review our institution's experience using these devices in terms of renal function.This is a retrospective review of all elective EVARs performed within a three-site health system (Florida, Minnesota, and Arizona) during the period of 2000 to 2018. The primary outcome was renal function decline on long-term follow-up depending on the anatomical fixation of the device (SuF vs InF). Secondary outcomes were length of hospitalization (LOH) and progression to hemodialysis. Multivariable regression analysis was performed to test for associations affecting LOH.There were 1130 elective EVARs included in our review. Of those, 670 (59.3%) had SuF and 460 (40.7%) InF. Long-term follow-up was 4.8 ± 3.7 years, and the rate of change in creatinine and estimated glomerular filtration rate (eGFR) were not statistically significant among groups (SuF vs InF). LOH was higher in those individuals with a SuF device (3.4 ± 2.2 vs 2.3 ± 1.0 days; P .001). Ten patients with chronic kidney disease progressed to hemodialysis at 6.7 ± 3.8 years from EVAR. On Kaplan-Meier analysis, patients with chronic kidney disease with SuF were more likely to progress to hemodialysis (P = .039). On multivariable regression, female sex (Coef, 2.4; 95% confidence interval [CI], 0.17-0.41; P = .02), SuF (Coef, 9.5; 95% CI, 0.11-1.11; P .0001), and intraoperative blood loss of greater than 150 mL (Coef, 15.4; 95% CI, 0.11-1.76; P .0001) were predictors of prolonged LOH.Our three-site, single-institution data indicate that, although the starting eGFR was statistically lower in those individuals undergoing elective EVAR with InF, device fixation type did not affect the creatinine and eGFR on long-term follow-up. However, caution should be exercised at the time of abdominal aortic aneurysm repair in those individuals who already presented with renal dysfunction. |
| Databáze: | OpenAIRE |
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