Editor's Choice – The Impact of Endovascular Aneurysm Repair on Long Term Renal Function Based on Hard Renal Outcomes

Abstract

This study assessed renal decline in patients who have undergone elective endovascular aneurysm repair (EVAR) over the long term (nine years of follow up), based on estimated glomerular filtration rate (eGFR). It appears that patients undergoing EVAR exhibit a significant loss of eGFR over the long term and this is associated with poor survival. This information is important for decision making when selecting patients suitable for EVAR, especially younger patients, and also for guiding follow up in this high risk patient group. Renal function preservation should become part of regular follow up in this setting, especially in male patients with established cardiovascular disease. Introduction: Over the short term endovascular aneurysm repair (EVAR) is associated with superior outcomes compared with open repair; however, the progression of renal function after EVAR remains unknown because of the use of inconsistent reporting measures. The aim was to define long term renal decline following elective EVAR using estimated glomerular filtration rate (eGFR). Methods: The prospectively maintained in house database was used to identify consecutive patients having elective EVAR who had been followed up for more than five years. Overall, 275 patients (23 females, 8%; mean age, 75 years) who were not previously on renal replacement therapy (RRT) were included (January 2000 to July 2010). Pre-operative, post-operative, and most recent eGFR values were evaluated using the chronic kidney disease epidemiology collaboration equation. The primary outcome was change in eGFR at latest follow up. Results: Patients were followed up over a median of 9 years (range 5e17 years). Their mean eGFR dropped from a pre-operative value of 67 mL/min/1.73 m 2 (standard deviation [SD]: 9.4) to 52 mL/min/1.73 m 2 (SD 7.7), which amounts to a yearly loss of 1.7 units; six patients (2%) required RRT (dialysis) during late follow up. Patients requiring RRT and those with an eGFR loss exceeding 20% at latest follow up compared with baseline were more likely to die during late follow up (odds ratio 2.4 and 3.3 respectively, p < .001). Conclusion: This analysis, with some of the longest available follow up to date, suggests that patients undergoing EVAR may experience a significant long term decrease in renal function. This needs to be taken into account when offering EVAR in younger patients; renal follow up and preservation should be optimised in this patient group.

Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Several observational studies have shown that CKD (eGFR <60 ml/min per 1.73 m 2 ) before surgery is associated with greater post-operative eGFR decline 59 and higher odds of eGFR loss >20% during long-term follow-up. 60,61 Similarly, CKD has been associated with higher 30-day and long-term mortality, higher risk of cardiovascular events, and longer length of hospital stay after AAA surgery (Figure 2). 62,63 Diagnostic evaluation and post-surgery follow-up of AAA in patients with CKD Duplex ultrasonography, computed tomographic angiography, and magnetic resonance angiography are commonly used for diagnosis of AAA.…”

Five Year Results of the French EPI-ANA-01 Registry of AnacondaTM Endografts in the Treatment of Infrarenal Abdominal Aortic Aneurysms

“…Furthermore, the evolution of glomerular filtration rates was not a criterion collected during the design of the study, which prevents conclusions on this important point, when recent results suggest that patients undergoing EVAR may experience a significant long term decrease in renal function. 37 Moreover, 81.8% of the centres included fewer than 10 patients per year in the study. Access to the overall number of endograft implantations performed in those centres is not available, but it is reasonable to think that some of them did not perform 10 EVAR cases per year, and performed even fewer EVAR cases per year with this specific endograft.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…AKI after F/BEVAR was found to be associated with decreased short-and long-term survival [299], although, it rarely results in permanent renal dysfunction as both sCr concentration and GFR returned to baseline by 6 months after the procedure as described by Wang et al [300]. Charles et al confirm higher mortality with eGFR loss at long term over a median of 9 years following EVAR, and observed long-term decrease of renal functions in some of the pts [301]. Gombert et al Investigated open repair for type II TAAAs if anatomically feasible [298].…”