Gender Differences in Renal Function and Volume Changes after Complex Aortic Repair
Ioana Antonescu, MD, FRCS(C), MSc, Raghu Vallabhaneni, MD, Mark A. Farber, MD.
UNCH, Chapel Hill, NC, USA.
Objectives: The incidence of acute renal insufficiency (AKI) after FEVAR is reported to be between 25 and 29% and its occurrence is a risk factor for the development of chronic renal dysfunction (CRF). There is conflicting evidence regarding the importance of ischemic parenchymal volume in the occurrence of post-procedure AKI. The current study seeks to elucidate this relationship.
Methods: This is a retrospective review of prospectively collected data over three years at a single high-volume institution. Between 2012 and 2015, data including follow-up parameters was available for 48 patients enrolled in a physician-sponsored investigation device exemption (PS-IDE) clinical trial. Patients were assessed clinically and with CT scans at discharge, 6, and 12 months. Renal function and volumes were evaluated with eGFR and TeraRecon respectively.
Results: Forty males and 8 females underwent fenestrated repair over the study period. Baseline age and co-morbidities, renal function, and mean aneurysm size were similar. Renal artery diameter and angulation were also similar for both kidneys. Sixteen patients had at least one accessory renal artery, of which three had two accessory vessels. Mean total procedure time and contrast volume was 252.7+/-79.1min and 95.4+/-43.4mL respectively. Pre-operative renal volumes were lower in females, with 320.6+/-86.9mm3 compared to 416.0+/-95.2mm3 in males (p=0.01). At six and 12 months, the decrease in total renal volumes was not significant and there was no difference between genders. Among patients with accessory renal arteries, volume changes were -36.5+/-25.1mm3 (-8.4%) and 2.0+/-11.3mm3 (0.7%) among males and females at six months (p=0.06) and -48.3+/-38.3mm3 (-11.1%) and 15.0+/-8.5mm3 (5.3%) at 12 months (p=0.04). The change in eGFR from baseline was not significant, including within the subgroup of patients with accessory renal arteries. Overall, the change in eGFR from baseline correlated weakly with the change in renal volume (Pearson correlation coefficient 0.09 and 0.12 at six and 12 months, p=NS). A trend towards correlation was observed among patients with accessory renal arteries at 12 months (Pearson correlation coefficient 0.5, p=0.08).
Conclusion: Renal volumes did not change from baseline after FEVAR and no gender difference was observed. In the subgroup of patients with accessory renal vessels, decrease in renal volumes may correlate with gender and decrease in renal function as estimated by eGFR. Further investigation is needed to validate these findings.
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