Change In Renal Anatomy After Fenestrated Endovascular Aortic Repair Affects Renal Function
Aleem K. Mirza, MD, Nedaa Skeik, MD, Jesse Manunga, MD.
Minneapolis Heart Institute, Minneapolis, MN, USA.
OBJECTIVES: Renal artery anatomy after fenestrated endovascular aortic repair (FEVAR) changes over time with aneurysm remodeling. However there is a paucity of data on the effect of renal anatomy change on renal function. The aim of this study was to evaluate the effect of renal anatomy change after FEVAR on renal function.
METHODS: We performed a retrospective review of a prospectively maintained database of all patients undergoing fenestrated endovascular aortic repair (FEVAR) between 2013 and 2019. Those who had renal incorporation with fenestrations were included. Patients were separated into two groups based on whether glomerular filtration rate (GFR) remained stable (sGFR) or declined (dGFR). Decline in GFR was defined as >30% from baseline. The groups were compared for change in renal artery anatomy using computed tomography angiography at preoperative and 1-year postoperative intervals. Anatomic variables included maximum aortic diameter, aortic-renal angulation (ARA), clock position, tortuosity index (TI), and post-stent angle (PSA).
RESULTS: A total of 173 patients (78.6% male; mean age 76.3±6.9 years) met inclusion criteria, including 142 patients (82%) sGFR and 31 patients (18%) dGFR. Coronary artery disease, hyperlipidemia, and BMI were higher in the sGFR group. The mean decrease in aortic diameter was 5.1±8.6mm, with greater sac regression in dGFR (8.9±6.9mm) compared to sGFR (4.3±8.7mm, P=.006). The mean change in ARA was 20.3±19.5 degrees for the right renal artery, and 14.1±24 degrees for the left renal artery. The change in ARA was greater in dGFR compared to sGFR for both the right renal artery (27.1±20 degrees vs. 18.8±19.1 degrees, P=.03), and the left renal artery (22±23 degrees vs. 12.3±23.9 degrees, P=.04). The median change in clock position was 7.5 degrees (IQR 0 - 7.5) dGFR compared to 0 degrees (IQR 0 - 7.5) sGFR, and was greater for the left renal artery (P=.02) but not the right (P=.09). The RRA had a higher median TI in dGFR (1.25, IQR 1.0-1.51) vs. sGFR (1.03, IQR 1.0-1.25; P=.016). However, the LRA had a lower TI in dGFR compared to sGFR (P=.005). There was no difference in median PSA between groups (P>.05).
CONCLUSIONS: A decrease in glomerular filtration rate after FEVAR was observed with change in renal anatomy. Specific anatomic factors that are associated with decreased GFR were sac regression, ARA and renal artery clock position.
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