Proximal Fixation Of Endovascular Aortic Device May Not Be Associated With Renal Function Decline After Abdominal Aortic Aneurysm Repair.

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Significant debate exists among providers who perform endovascular abdominal aortic aneurysm repair (EVAR) regarding the renal function change between suprarenal and infrarenal fixation devices. The purpose of this study is to review our institution’s experience using these devices in terms of renal function.This is a retrospective review of all elective EVARs performed within a three-site health system (Florida, Minnesota and Arizona) during the period 2000-2018. The primary outcome was renal function decline on long-term follow-up depending on the anatomical fixation of the device (suprarenal [SuF] versus infrarenal [InF]). Secondary outcomes were length of hospitalization (LOH) and progression to hemodialysis. Multivariable regression analysis was performed to test for associations affecting LOH.There were 1,130 elective EVARs included in our review. Of those, 670 (59.3%) had SuF and 460 (40.7%) InF. Long-term follow-up was 4.8±3.7 years and the rate of change in Creatinine and estimated glomerular filtration rate (eGFR) were not statistically significant among groups (SuF versus InF). LOH was higher in those individuals with a SuF device (3.4±2.2 versus 2.3±1.0 days, p<0.001). Ten patients with chronic kidney disease (CKD) progressed to hemodialysis at 6.7±3.8 years from EVAR. On Kaplan-Meier analysis, CKD patients with SuF were more likely to progress to hemodialysis (p=0.039). On multivariable regression, female sex (Coef: 2.4, 95% CI 0.17-0.41, p=0.02) and SuF (Coef: 9.5, 95% CI 0.11-1.11, p<0.0001) and intra-operative blood loss of greater than 150mL (Coef: 15.4, 95% CI 0.11-1.76, p<0.0001)were predictors of prolonged LOH.Our three-site, single institution data indicate that although the starting eGFR was statistically lower in those individuals undergoing elective EVAR with InF; device fixation type did not affect the Creatinine and eGFR on long-term follow-up. However, caution should be exercised at the time of AAA repair in those individuals who already presented with renal dysfunction.

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Authors: Y Erben, Y Li, M A Mao, O S Hamid, C Franco-Mesa, J A Da Rocha-Franco, W Stone, R J Fowl, W A Oldenburg, H Farres, A J Meltzer, P Gloviczki, R R De Martino, T C Bower, M Kalra, G S Oderich, A G Hakaim