Effects Of Preoperative Renal Artery Stenosis On Outcomes After Fenestrated/branched Endovascular Aortic Aneurysm Repair (f-bevar)
Carla K. Scott, MD, Anna L. Driessen, MD, Marilisa S. Gonzalez, MD, Fatemeh Malekpour, MD, Gerardo G. Guardiola, MD, Mirza S. Baig, MD, Melissa L. Kirkwood, MD, Carlos H. Timaran, MD.
UT Southwestern, Dallas, TX, USA.
Objective: Whether branch stability, renal function and survival are affected by preoperative significant renal artery stenosis (RAS) is unknown. This aim of this study was to assess the effects of preoperative RAS on outcomes after F-BEVAR.Methods: During a 5-year period, 321patients (72% male) underwent F-BEVAR for 76(24%) juxtarenal, 117(36%) suprarenal and 128(40%) thoracoabdominal aortic aneurysms. Preoperative significant RAS was defined as a CTA-based intraluminal diameter reduction >50%. Renal decline was defined as a drop in glomerular filtration rate (GFR)<60 mL/min/1.73m2 for patients with normal renal function and GFR decrease > 20% or progression in chronic kidney disease (CKD) stage for patients with baseline renal dysfunction. Primary endpoints included renal artery primary patency, freedom from branch instability, renal function and patient survival. Results: Median age was 72 years (interquartile range, 68-79 years). Technical success was 99%. In-patient/30-day mortality was 2.8%. Among 613 stented renal arteries, 507(83%) were fenestrations and 106(17%) branches. Significant preoperative RAS was identified in 87 patients(27%) and 18(5.6%) had bilateral RAS. Post-operative acute kidney injury was diagnosed in 38 patients(11.8%); 10(11%) had RAS and 28(12%) had normal renal arteries (P=.91). The mean follow-up was 23±22.7 months. Primary patency rates at 12, 36 and 60 months were 98%, 97% and 97% for the renal arteries, respectively. RAS did not affect either primary patency (99%, 99% and 99% vs. 98%, 96% and 95% among patients with and without RAS at 12, 36 and 60 months, respectively; P=.19) or freedom from branch instability (98%, 96% and 96%, vs. 97%, 95% and 93%;P=.47). Renal decline was similar in patients with and without stenosis (17%vs.24%, respectively; P=.17). Overall survival rate was 91%, 76% and 66% at 12, 36 and 60 months, respectively. Survival rates at 12, 36, and 60 months were not significantly different in patients with and without RAS (90%, 75% and 65% vs. 91%, 79% and 66%, respectively;P=.34). No patients progressed to permanent renal replacement therapy.Conclusion: F-BEVAR is associated with overall primary patency rates higher than 90% for the renal arteries. As with incidental RAS, preoperative RAS did not affect primary patency, freedom from branch or patient survival after F-BEVAR. Renal decline was not more frequent among patients with RAS. Long-term outcomes of patients with RAS undergoing F-BEVAR remain to be elucidated.
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