Gray, Daphne Elisabeth, Eisenack, Markus, Gawenda, Michael, Torsello, Giovanni, Majd, Payman, Brunkwall, Jan, Osada, Nani and Donas, Konstantinos P. (2017). Repeated contrast medium application after endovascular aneurysm repair and not the type of endograft fixation seems to have deleterious effect on the renal function. J. Vasc. Surg., 65 (1). S. 46 - 52. NEW YORK: MOSBY-ELSEVIER. ISSN 0741-5214

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Abstract

Objective: The influence of endovascular aneurysm repair (EVAR) on renal function is of high concern. The question whether stent graft fixation type plays a significant role in renal outcome after EVAR is still debated. However, other factors, such as repeated contrast medium exposure, should also be considered. Methods: We performed a two-center, stratified-cohort case control study to evaluate the influence of last-generation abdominal endografts with suprarenal (SR) vs infrarenal (IR) fixation on renal function. Results: From a total of 276 patients, 134 were treated with IR fixation (group A) and 142 with SR fixation (group B) stent grafts. There was no significant difference in intraoperative contrast medium use (mean 120.0 mL group A vs 104.8 mL; P = .087) between the two cohorts. Overall, 11.2% of the patients (31/276) showed a relevant decline (>= 20%) of estimated glomerular filtration rate (eGFR) postoperative and 11.5% (31/269) after 12 months. Furthermore, 19/134 (14.2%) patients in group A and 12/142 (8.5%) patients in group B showed a postoperative decrease of eGFR >= 20% (P = .132). Comparing the 12-month follow up, there was also no significant difference between the two groups (group A, n = 18/134; group B, n = 13/135; P = .329). Patients with only one contrast-enhanced computed tomography scan postoperatively (4/102; 3.9%) showed significant less renal deterioration after 12 months compared with the rest of the study collectively (27/166; 16.9%; P = .002). Comparing IR vs SR fixation in these patients, there was no significant difference between the two groups. One patient (1/35; 2.9%) with IR fixation (group A) and 3/67 (4.5%) with SR fixation (group B) showed a decline in eGFR values of $ 20% after 12 months (P = 1.0). Conclusions: Our study showed no significant difference in renal impairment between SR and IR fixation in EVAR for IR abdominal aortic aneurysm. However, significantly more renal deterioration was observed in patients with increased postoperative contrast medium expose. Therefore, alternatives such as contrast-enhanced duplex ultrasound or magnetic resonance imaging for EVAR surveillance should be considered.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Gray, Daphne ElisabethUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eisenack, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gawenda, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Torsello, GiovanniUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Majd, PaymanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brunkwall, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Osada, NaniUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Donas, Konstantinos P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-243694
DOI: 10.1016/j.jvs.2016.05.088
Journal or Publication Title: J. Vasc. Surg.
Volume: 65
Number: 1
Page Range: S. 46 - 52
Date: 2017
Publisher: MOSBY-ELSEVIER
Place of Publication: NEW YORK
ISSN: 0741-5214
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ABDOMINAL AORTIC-ANEURYSM; GLOMERULAR-FILTRATION-RATE; COMPUTED-TOMOGRAPHY; STENT-GRAFTS; INFRARENAL FIXATION; PROXIMAL FIXATION; FOLLOW-UP; IMPACT; DYSFUNCTION; EXPERIENCEMultiple languages
Surgery; Peripheral Vascular DiseaseMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/24369

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