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Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate.
J Vasc Surg. 2008 Jun; 47(6):1141-9.JV

Abstract

OBJECTIVE

It has been suggested that endovascular aneurysm repair (EVAR) in concert with serial contrast-enhanced computed tomography (CT) surveillance adversely impacts renal function. Our primary objectives were to assess serial renal function in patients undergoing EVAR and open repair (OR) and to evaluate the relative effects of method of repair on renal function.

METHODS

A thorough retrospective chart review was performed on 223 consecutive patients (103 EVAR, 120 OR) who underwent abdominal aortic aneurysm (AAA) repair. Demographics, pertinent risk factors, CT scan number, morbidity, and mortality were recorded in a database. Baseline, 30- and 90-day, and most recent glomerular filtration rate (GFR) were calculated. Mean GFR changes and renal function decline (using Chronic Kidney Disease [CKD] staging and Kaplan-Meier plot) were determined. EVAR and OR patients were compared. CKD prevalence (>or=stage 3, National Kidney Foundation) was determined before repair and in longitudinal follow-up. Observed-expected (OE) ratios for CKD were calculated for EVAR and OR patients by comparing observed CKD prevalence with the expected, age-adjusted prevalence.

RESULTS

The only baseline difference between EVAR and OR cohorts was female gender (4% vs 12%, P = .029). Thirty-day GFR was significantly reduced in OR patients (P = .047), but it recovered and there were no differences in mean GFR at a mean follow-up of 23.2 months. However, 18% to 39% of patients in the EVAR and OR groups developed significant renal function decline over time depending on its definition. OE ratios for CKD prevalence were greater in AAA patients at baseline (OE 1.28-3.23, depending upon age group). During follow-up, the prevalence and severity of CKD increased regardless of method of repair (OE 1.8-9.0). Deterioration of renal function was independently associated with age >70 years in all patients (RR 2.92) and performance of EVAR compared with OR (RR 3.5) during long-term follow-up.

CONCLUSIONS

Compared with EVAR, OR was associated with a significant but transient fall in GFR at 30 days. Renal function decline after AAA repair was common, regardless of method, especially in patients >70 years of age. However, the renal function decline was significantly greater by Kaplan-Meier analysis in EVAR than OR patients during long-term follow-up. More aggressive strategies to monitor and preserve renal function after AAA repair are warranted.

Authors+Show Affiliations

The University of Arizona Health Sciences Center, University Medical Center, Tucson, AZ 85724, USA. jmills@u.arizona.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

18514831

Citation

Mills, Joseph L., et al. "Comparison of the Effects of Open and Endovascular Aortic Aneurysm Repair On Long-term Renal Function Using Chronic Kidney Disease Staging Based On Glomerular Filtration Rate." Journal of Vascular Surgery, vol. 47, no. 6, 2008, pp. 1141-9.
Mills JL, Duong ST, Leon LR, et al. Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate. J Vasc Surg. 2008;47(6):1141-9.
Mills, J. L., Duong, S. T., Leon, L. R., Goshima, K. R., Ihnat, D. M., Wendel, C. S., & Gruessner, A. (2008). Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate. Journal of Vascular Surgery, 47(6), 1141-9. https://doi.org/10.1016/j.jvs.2008.01.039
Mills JL, et al. Comparison of the Effects of Open and Endovascular Aortic Aneurysm Repair On Long-term Renal Function Using Chronic Kidney Disease Staging Based On Glomerular Filtration Rate. J Vasc Surg. 2008;47(6):1141-9. PubMed PMID: 18514831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate. AU - Mills,Joseph L,Sr AU - Duong,Son T, AU - Leon,Luis R,Jr AU - Goshima,Kaoru R, AU - Ihnat,Daniel M, AU - Wendel,Christopher S, AU - Gruessner,Angelika, PY - 2007/09/20/received PY - 2008/01/13/revised PY - 2008/01/20/accepted PY - 2008/6/3/pubmed PY - 2008/7/11/medline PY - 2008/6/3/entrez SP - 1141 EP - 9 JF - Journal of vascular surgery JO - J Vasc Surg VL - 47 IS - 6 N2 - OBJECTIVE: It has been suggested that endovascular aneurysm repair (EVAR) in concert with serial contrast-enhanced computed tomography (CT) surveillance adversely impacts renal function. Our primary objectives were to assess serial renal function in patients undergoing EVAR and open repair (OR) and to evaluate the relative effects of method of repair on renal function. METHODS: A thorough retrospective chart review was performed on 223 consecutive patients (103 EVAR, 120 OR) who underwent abdominal aortic aneurysm (AAA) repair. Demographics, pertinent risk factors, CT scan number, morbidity, and mortality were recorded in a database. Baseline, 30- and 90-day, and most recent glomerular filtration rate (GFR) were calculated. Mean GFR changes and renal function decline (using Chronic Kidney Disease [CKD] staging and Kaplan-Meier plot) were determined. EVAR and OR patients were compared. CKD prevalence (>or=stage 3, National Kidney Foundation) was determined before repair and in longitudinal follow-up. Observed-expected (OE) ratios for CKD were calculated for EVAR and OR patients by comparing observed CKD prevalence with the expected, age-adjusted prevalence. RESULTS: The only baseline difference between EVAR and OR cohorts was female gender (4% vs 12%, P = .029). Thirty-day GFR was significantly reduced in OR patients (P = .047), but it recovered and there were no differences in mean GFR at a mean follow-up of 23.2 months. However, 18% to 39% of patients in the EVAR and OR groups developed significant renal function decline over time depending on its definition. OE ratios for CKD prevalence were greater in AAA patients at baseline (OE 1.28-3.23, depending upon age group). During follow-up, the prevalence and severity of CKD increased regardless of method of repair (OE 1.8-9.0). Deterioration of renal function was independently associated with age >70 years in all patients (RR 2.92) and performance of EVAR compared with OR (RR 3.5) during long-term follow-up. CONCLUSIONS: Compared with EVAR, OR was associated with a significant but transient fall in GFR at 30 days. Renal function decline after AAA repair was common, regardless of method, especially in patients >70 years of age. However, the renal function decline was significantly greater by Kaplan-Meier analysis in EVAR than OR patients during long-term follow-up. More aggressive strategies to monitor and preserve renal function after AAA repair are warranted. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/18514831/Comparison_of_the_effects_of_open_and_endovascular_aortic_aneurysm_repair_on_long_term_renal_function_using_chronic_kidney_disease_staging_based_on_glomerular_filtration_rate_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(08)00176-6 DB - PRIME DP - Unbound Medicine ER -