Incidence of acute and chronic renal failure following branched endovascular repair of complex aortic aneurysms.
The purpose of this study was to examine the incidence of acute kidney injury and chronic renal impairment following branched endovascular aneurysm repair (BEVAR) of complex thoracoabdominal aortic aneurysms (TAAA) using the Medtronic Valiant Thoracoabdominal Aortic Aneurysm stent graft system (MVM), the physician-modified Visceral Manifold (pmMVM), and Unitary Manifold (UVM) stent graft systems. The objective was to report the acute and chronic renal function changes in patients following complex TAAA aneurysm repair.This is an analysis of 139 patients undergoing branched endovascular repair for complex TAAAs between 2012 and 2020. Patient renal function was evaluated using serum creatinine and estimated glomerular filtration rate at baseline, 48 hours, discharge, one month, six months, and annually to two years. Patients on dialysis prior to the procedure were excluded from data analysis.A total of 139 patients (mean age 71.13; 64.7% male) treated for TAAA with BEVAR met inclusion criteria and were evaluated. A total of 530 visceral vessels were stented. A majority of patients (n=131, 94.2%) underwent a single procedure while eight required staged procedures. Thirty-day, one-year and two-year all-cause mortality rates were 5.8%, 25.2%, and 32.4%, respectively. Primary and secondary patency rates at a median follow-up of 26.9 months (95% CI; 21.1 – 32.7) were 96.2% and 97.5% for all vessels and 95.4% and 96.9% for renal arteries, respectively. Postoperative acute kidney injury (AKI) was identified in 22 (15.8%) patients. At discharge, 16 patients (11.6%) had an increase in CKD stage with three requiring permanent dialysis. Five additional patients required permanent dialysis over the two-year follow-up period for a total of 8 (5.8%). Increasing age (HR=1.0327, p=0.0477), hemoglobin <7 prior to procedure (HR=2.4812, p=0.0093), increasing maximum aortic diameter (HR=1.0189, p=0.0084), presence of AKI (HR=2.0757, p=0.0182), and increase in CKD stage (HR=1.3520, p=0.002) at discharge were significantly associated with decreased patient survival.Postoperative AKI and a chronic decline in renal function continue to be problematic in endovascular repair of complex aortic aneurysms. This study found that BEVAR using the manifold configuration resulted in immediate and mid-term renal function that is comparable to similar analyses of branched and/or fenestrated grafts.
Authors: Matthew J Lommen, Jack J Vogel, Angela VandenHull, Valerie Reed, Kathryn Pohlson, Geoffrey A Answini, Thomas S Maldonado, Thomas C Naslund, Murray L Shames, Patrick W Kelly