<b>Renal Infarction following Endovascular Aortic Aneurysm Repair</b>: Incidence and Clinical Consequences

Krämer, Stefan; Seifarth, Harald; Pamler, Reinhard; Fleiter, Thorsten; Bühring, Julia; Sunder‐Plassmann, L.; Brambs, Hans‐Jürgen; Görich, Johannes

doi:10.1177/152660280200900116

Cited by 71 publications

(57 citation statements)

References 23 publications

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“…We were unable to contact the authors for clarification so this series was excluded. 24 The remaining 11 studies were eligible for the meta-analysis. ‡ Study characteristics and quality.…”

Section: Resultsmentioning

confidence: 99%

Suprarenal endograft fixation and medium-term renal function: Systematic review and meta-analysis

Walsh

Boyle

Lynch

et al. 2008

Journal of Vascular Surgery

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Currently available data are insufficient to determine the precise effect of suprarenal fixation on medium-term renal function. Conventional Kaplan-Meier analysis of the pooled data set suggested that suprarenal fixation increased the risk of renal dysfunction; however, the effect disappeared when sophisticated statistical modelling was performed to account for study heterogeneity. A randomised controlled trial of suprarenal fixation may resolve this issue.

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Section: Resultsmentioning

confidence: 99%

Suprarenal endograft fixation and medium-term renal function: Systematic review and meta-analysis

Walsh

Boyle

Lynch

et al. 2008

Journal of Vascular Surgery

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“…The presence of renal dysfunction after EVAR with suprarenal fixation appears to be multifactorial and transient in most patients. 285 Nonetheless, renal artery occlusion and infarctions have been reported in patients with preexisting renal artery occlusive disease 286,287 and, while infrequent, visceral dysfunction and celiac or mesentery artery occlusion may occur secondary to suprarenal fixation. 288,289 Recommended management of the internal iliac artery.…”

Section: Endovascular Repairmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

628

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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“…In a retrospective comparison of endografts with transrenal fixation to those with infrarenal fixation only, transrenal fixation was associated with a trend for higher incidence of small renal infarcts, but with no short-or mid-term impairment of renal function.3 Similarly, in a study that included 99 patients with Vanguard (Boston Scien-tific Corp., Natick, Mass), Talent (Medtronic, Sunnyvale, Calif), Excluder (Gore and Assoc, Flagstaff, Ariz), Corvita (Boston Scientific Corp), AneuRx, Lifepath (Baxter Healthcare, Irvine, Calif), and Zenith (Cook Inc., Bloomington, Indiana) devices, renal infarction rate was 8.7% in 69 renal arteries with bare stents extending through the ostium, and 5.6% in the 124 arteries with infrarenal fixation alone. 4 In large clinical series of EVAR, renal artery coverage is reported to occur with less than 1% frequency. In 128 patients treated with the AneuRx device, one suprarenal deployment occurred, which was corrected with intraoperative repositioning of the fully deployed endograft.6 Neither accidental renal artery coverage nor any secondary interventions for renal complications were reported in two other series of 179 and 239 EVAR with a variety of different endografts.7,8 In another series, homemade and Talent-LPS transrenal devices were used in 192 patients and renal artery coverage by the graft material was reported only in 2 cases.…”

Section: Discussionmentioning

confidence: 99%

Renal Artery Coverage During Endovascular Aortic Aneurysm Repair: Proximal Migration or Misplacement of the Stent-Graft?

Reed

Mózes

Carmo

et al. 2004

Perspectives in Vascular Surgery and Endovascular Therapy

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Partial or complete coverage of the renal arteries by the stent-graft during endovascular abdominal aortic aneurysm repair is a serious problem. We present two cases with this complication; both were successfully managed using renal artery stents. To minimize the risk of renal artery coverage, completion aortography with good visualization of the renal arteries is recommended. Even a slight increase in serum creatinine after endovascular abdominal aortic aneurysm repair can be a sign of renal artery coverage due to early proximal migration or misplacement during deployment. Computed tomographic scan with and without intravenous contrast is recommended to establish the right diagnosis. Early stenting of the renal arteries is usually possible and associated with an excellent prognosis.

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Renal Infarction following Endovascular Aortic Aneurysm Repair: Incidence and Clinical Consequences

Abstract: Documented renal infarctions following endovascular aortic stent-graft placement are not common and do not appear to be associated with suprarenal endograft fixation.

Cited by 71 publications

References 23 publications

Suprarenal endograft fixation and medium-term renal function: Systematic review and meta-analysis

Suprarenal endograft fixation and medium-term renal function: Systematic review and meta-analysis

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Renal Artery Coverage During Endovascular Aortic Aneurysm Repair: Proximal Migration or Misplacement of the Stent-Graft?

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