Renal interventions during endovascular aneurysm repair

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Cardiology

Background:

• Renal insufficiency is a significant risk factor for mortality and morbidity following endovascular aneurysm repair (EVAR).
• Practices have evolved to minimize renal injury and dysfunction during EVAR.
• Transrenal fixation techniques may lead to medium-term renal function decline.

Purpose of the Study:

• To evaluate the renal outcomes associated with various renal interventions during complex EVAR.
• To assess the risks and benefits of transrenal fixation and renal stenting in the context of EVAR.
• To highlight the need for improved device development in renal interventions during EVAR.

Main Methods:

• Review of renal interventions, including chimney, snorkel, periscope techniques, and fenestrated grafts in EVAR.
• Analysis of medium-term renal function changes associated with transrenal fixation.
• Evaluation of consequences of renal stenting for athero-occlusive disease during EVAR.

Main Results:

• Complex EVAR with renal interventions demonstrates resilience, with approximately 10% of patients experiencing renal issues.
• Transrenal fixation is associated with an increased risk of renal function decline in the medium term.
• Renal stenting for athero-occlusive disease during EVAR presents challenges, including unexpected early vessel occlusion.

Conclusions:

• Renal interventions during complex EVAR are generally well-tolerated, but specific techniques require careful patient selection and monitoring.
• Further device innovation is necessary to improve safety and efficacy of renal interventions in EVAR.
• The evolving landscape of EVAR necessitates a thorough understanding of renal complication risks and mitigation strategies.