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Volumetric Nephrogram Represents Renal Function and Complements Aortic Anatomic Severity Grade in Predicting EVAR

Mark D Balceniuk¹, Lauren Trakimas¹, Claudia Aghaie¹

¹1 Strong Memorial Hospital, University of Rochester, Rochester, NY, USA.

Vascular and Endovascular Surgery

|March 27, 2018

Summary

Volumetric nephrogram (VN) predicts chronic kidney disease (CKD) in patients undergoing endovascular aortic repair. VN complements anatomic severity grade (ASG) in assessing cardiovascular health and predicting EVAR outcomes.

Keywords:

anatomic severity grade chronic kidney disease volumetric nephrogram

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Area of Science:

Vascular Surgery
Nephrology
Radiology

Background:

Chronic kidney disease (CKD) is a significant predictor of adverse outcomes in patients undergoing endovascular aortic aneurysm repair (EVAR).
Anatomic severity grade (ASG) quantifies anatomical suitability for EVAR but may not fully capture all risk factors.
Novel imaging metrics are needed to enhance risk stratification for EVAR.

Purpose of the Study:

To identify a novel renal perfusion metric to assist ASG in predicting EVAR outcomes.
To evaluate the volumetric nephrogram (VN) as a predictor of CKD.
To explore the relationship between VN, ASG, and overall cardiovascular health.

Main Methods:

Retrospective review of 386 elective infrarenal EVAR cases.
Independent reviewers assessed ASG.
Volumetric software calculated kidney volume and the novel volumetric nephrogram (VN).
Linear regression and receiver-operator analysis evaluated the correlation of kidney volume and VN with CKD and ASG.

Main Results:

Renal volume <281 mL and VN <22.5 HU·L significantly correlated with CKD (AUC = 0.708 and 0.764, respectively).
High ASG scores correlated with both renal volume and VN (AUC = 0.628 for both).
A strong inverse relationship was observed between ASG and VN (R² = 0.95).

Conclusions:

VN is a robust predictor of CKD in EVAR patients.
An inverse relationship exists between renal function (VN) and ASG, previously undescribed.
VN complements ASG in assessing cardiovascular health and atherosclerotic burden, suggesting anatomical factors contribute to poor renal function outcomes in EVAR.