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Benchmark renal outcome measures of open repair of complex abdominal aortic aneurysms for comparison with fenestrated endografts
Alexandre A. Pereira, MD, Gustavo S. Oderich, MD, Tiziano Tallarita, MD, Manju Kalra, MBBS, Audra A. Duncan, MD, Peter Gloviczki, MD, Thanila A. Macedo, MD, Stephen Cha, Thomas C. Bower, MD.
Mayo Clinic, Rochester, MN, USA.
Purpose: Renal outcomes after open repair of complex abdominal aortic aneurysms (cAAA) have been poorly described. This study provides a detailed, long-term analysis of clinical and anatomical renal outcome measures in a cohort of patients treated by open repair of cAAAs.
Methods: We retrospectively reviewed 461 patients treated by open repair of juxtarenal, suprarenal and type IV thoracoabdominal aneurysms (TAAA) between 2000 and 2010. Renal outcome measures included changes in laboratory and clinical markers (serum creatine, estimated glomerular filtration rate [eGFR], renal replacement therapy [RRT]) and anatomical parameters (pole-pole kidney length, cortical-medullary thickness [CMT] and new diagnosis of renal infarct, renal artery stenosis or occlusion). Anatomical parameters were independently reviewed by two investigators in 200 patients who had paired CT studies obtained prior to and >12 months after the operation. Renal function deterioration (RFD) was defined by >30% decrease in eGFR. End-points were freedom from RFD, RRT, and changes in anatomical measurements.
Results: There were 354 male and 107 female patients with mean age of 73±8 years. Operative mortality was 1.3% (6/461). Early RFD occurred in 184 patients (40%), returning to baseline values within 3 months in all except for 16 patients (8%). Other 8 patients (4%) had additional RFD >3 months after the operation. RRT was required in 8 patients (4%), and was permanent in four (2%). After a median follow up of 44 months, freedom from RFD at 5-years was 87±3%, 85±5%, and 65±9% for juxtarenal, suprarenal, and type IV TAAAs, respectively. Independent predictors of RFD were renal artery disease and increasing level of aneurysm complexity. Anatomical changes included a decrease in kidney length in 60 patients (30%, mean 2.5mm), decrease in CMT in 20 (10%, mean 1mm), and new diagnosis of renal infarct in 12 (6%) or renal artery stenosis/occlusions in 24 (12%).
Conclusion: RFD was common (40%) after open cAAA repair, but most patients (92%) returned to their baseline values within 3 months. The presence of renal artery disease and increasing level of aneurysm complexity correlated with higher rates of RFD. These renal outcome measures herein described provide a benchmark for future comparison with studies evaluating the use of fenestrated endografts.
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