Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology

O’Donnell, Mark E.; Sun, Zhonghua; Winder, R. J.; Ellis, Peter; Lau, Louis; Blair, Paul

doi:10.1016/j.jvs.2006.12.017

Cited by 37 publications

(35 citation statements)

References 39 publications

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“…To date, several observational studies have reported the efficacy and safety of suprarenal endograft fixation. [280][281][282][283][284] Moreover, almost 50% and 87% of endografts used in the DREAM and EVAR-1 trials, respectively, were performed with endografts that used suprarenal fixation. Significantly, rates of renal dysfunction appear to be equivalent for endografts with transrenal nitinol or stainless steel stents and not significantly different among patients undergoing EVAR with infrarenal or suprarenal fixation.…”

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

625

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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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

625

520

View full text Add to dashboard Cite

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“…Despite initial concerns about suprarenal stent struts impinging the renal ostium, the risk of embolization, 59 or peri-strut neointimal hyperplasia, 60 we, like previous authors, 61 successfully used suprarenal fixation without any adverse effects on renal function even after 4 years' follow-up. 17 Leurs et al 62 have analyzed the EUROSTAR registry data and reported that neck lengths ,15 mm predispose to increased risk of short-and midterm proximal endoleaks post EVAR.…”

Section: ¤ ¤mentioning

confidence: 80%

Clinical Efficacy and Cost per Quality-Adjusted Life Years of Pararenal Endovascular Aortic Aneurysm Repair Compared With Open Surgical Repair

Sultan¹,

Hynes²

2011

Journal of Endovascular Therapy

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“…Because there is no fabric attached to the stent, the mesenteric and renal arteries remain perfused, although concerns have been raised regarding the potential risks of embolization to or occlusion of the renal and/or mesenteric arteries by the suprarenal components (20). Several studies have reported the safety and efficacy of suprarenal fixation (21)(22)(23)(24)(25), with similar rates of renal dysfunction in EVAR performed with suprarenal and infrarenal fixation (24). However, there are reports of renal infarction and renal artery occlusions in patients with preexisting renal arterial disease (26,27), as well as of visceral compromise and arterial occlusion (28,29) with the use of suprarenal fixation.…”

Section: Endovascular Aneurysm Repairmentioning

confidence: 99%

Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association

Walker

Kalva

Yeddula

et al. 2010

Journal of Vascular and Interventional Radiology

130

102

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Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology

Abstract: RAO coverage by suprarenal uncovered stents does not appear to have a significant effect on renal function as evaluated by creatinine measurements in patients with normal preoperative renal function.

Cited by 37 publications

References 39 publications

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

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

Clinical Efficacy and Cost per Quality-Adjusted Life Years of Pararenal Endovascular Aortic Aneurysm Repair Compared With Open Surgical Repair

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