Incidence of Acute and Chronic Renal Failure Following Branched Endovascular Repair of Complex Aortic Aneurysms

Abstract

Background:The purpose of this study was to examine the incidence of acute kidney injury and chronic renal impairment following branched endovascular aneurysm repair (BEVAR) of complex thoracoabdominal aortic aneurysms (TAAA) using the Medtronic Valiant Thoracoabdominal Aortic Aneurysm stent graft system (MVM), the physician-modified Visceral Manifold, and Unitary Manifold stent graft systems. The objective was to report the acute and chronic renal function changes in patients following complex TAAA aneurysm repair. Methods: This is an analysis of 139 patients undergoing branched endovascular repair for complex TAAAs between 2012 and 2020. Patient renal function was evaluated using serum creatinine and estimated glomerular filtration rate at baseline, 48 hr, discharge, 1 month, 6 months, and annually to 2 years. Patients on dialysis prior to the procedure were excluded from data analysis. Results: A total of 139 patients (mean age 71.13; 64.7% male) treated for TAAA with BEVAR met inclusion cr iter ia and were evaluated. A total of 530 visceral vessels were stented. A majority of patients ( n = 131, 94.2%) underwent a single procedure while 8 required staged procedures. Thirty-day, 1-year and 2-year all-cause mortality rates were 5.8%, 25.2%, and 32.4%, respectively. Primary and secondary patency rates at a median follow-up of 26.9 months (95% CI; 21.1 -32.7) were 96.2% and 97.5% for all vessels and 95.4% and 96.9% for renal arteries, respectively. Postoperative acute kidney injury (AKI) was identified in 22 (15.8%) patients. At discharge, 16 patients (11.6%) had an increase in CKD stage with 3 requiring permanent dialysis. Five additional patients required permanent dialysis over the 2-year follow-up period for a total Conflicts of Interest: PK has received payments related to license and royalty interest with Medtronic; KP has received payments related to license and royalty interest with Medtronic; AV has received payments related to license and royalty interest with Medtronic; GA is a paid consultant for Medtronic; MS is on advisory boards and is a speaker for Medtronic and Gore and is a speaker for Cook; ML, JV, VB, TM and TN have no competing interests.

Branched and Fenestrated Aortic Endovascular Grafts

“…In 2001, this group reported their analysis of 139 patients who underwent treatment with the Medtronic Valiant thoracoabdominal stent graft system. 13 The majority of patients (94.2%) underwent a single procedure rather than staged delivery of the branch grafts. Thirty-day, 1-year, and 2-year all-cause mortality rates were 5.8%, 25.2%, and 32.4%, respectively.…”