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Renal function changes after fenestrated endovascular aneurysm repair.

Kenneth Tran1, Andres Fajardo2, Brant W Ullery1

  • 1Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif.

Journal of Vascular Surgery
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Summary

Fenestrated endovascular aneurysm repair (fEVAR) can lead to acute and chronic kidney dysfunction in about a quarter of patients, mostly mild. Baseline kidney disease should not prevent fEVAR, and regular monitoring is crucial.

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Medical Device Technology

Background:

  • Limited data exists on the impact of fenestrated endovascular aneurysm repair (fEVAR) on renal function.
  • Assessing renal function changes post-fEVAR is crucial for patient management.

Purpose of the Study:

  • To comprehensively analyze acute and chronic renal function changes in patients following fEVAR.
  • To evaluate the incidence and severity of renal dysfunction after fEVAR.

Main Methods:

  • Retrospective analysis of 110 patients undergoing fEVAR for juxtarenal or paravisceral aortic aneurysms.
  • Glomerular filtration rate (GFR) estimated using the Modification of Diet in Renal Disease (MDRD) formula.
  • Renal dysfunction assessed using RIFLE criteria for acute kidney injury and CKD staging for chronic changes.

Main Results:

  • 22.7% of patients experienced acute kidney injury (AKI), predominantly mild.
  • 51% had moderate chronic kidney disease (CKD) at baseline; 73.7% showed no change or improvement in CKD stage during follow-up.
  • Clinically significant renal dysfunction occurred in 26.2% of patients; age was an independent risk factor for long-term decline.

Conclusions:

  • Both acute and chronic renal dysfunction occur in approximately 25% of patients post-fEVAR, with most cases being mild.
  • Mild to moderate baseline kidney disease should not be a contraindication for fEVAR in the juxtarenal population.
  • Routine monitoring of renal function and branch vessel patency is essential after fEVAR.