Suprarenal versus infrarenal stent graft fixation on renal complications after endovascular aneurysm repair

Miller, Larry E.; Razavi, Mahmood K.; Lal, Brajesh K.

doi:10.1016/j.jvs.2015.01.037

Cited by 36 publications

(37 citation statements)

References 38 publications

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“…These include rates reported by Pisimisis (Infrarenal: 15% vs. Suprarenal: 19%), Alsac (Infrarenal: 30% vs. Suprarenal: 26%), and Miller (Infrarenal: 12.1% vs. Suprarenal: 12.3%). 7–10, 19, 20 Notably, however, several of these studies report outcomes from different time points, including mid-term as well as 30-day outcomes. Additionally, overall improvements in patient outcomes following EVAR have likely occurred over the last decade, related to surgeon experience and device evolution.…”

Section: Discussionmentioning

confidence: 99%

“…10, 22 Walsh et al included 11 studies between 1998 and 2006 and found increased renal impairment following suprarenal fixation. However, this effect was eliminated after adjustment for the significant heterogeneity of studies, and the authors concluded that given limitations of current reports, the data were insufficient to determine the precise effect of suprarenal fixation on renal function.…”

Section: Discussionmentioning

confidence: 99%

“…22 In 2015, Miller et al published a similar meta-analysis of 21 studies including endografts from 1994–2011 and concluded that type of fixation did not impact renal complications, despite higher rates of renal infarction among suprarenal grafts (6.4% vs. 2.5%, P = 0.09). 10 Importantly, however, the authors appropriately note the challenges to this work including the fact that only one study included results from more than two centers, and no studies included patients beyond 2011. 23 Perhaps most importantly, however, neither meta-analysis was able to evaluate the specific endografts, and a wide variety of grafts were studied including many not available today, including surgeon-made endografts.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Renal Complications between Endografts with Suprarenal and Infrarenal Fixation

Zettervall

Soden

Deery

et al. 2017

European Journal of Vascular and Endovascular Surgery

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Objectives Surgeons have multiple grafts options available for the endovascular treatment of abdominal aortic aneurysms (EVAR), and some hypothesize that suprarenal fixation endografts may result in higher rates of renal complications than infrarenal endografts. This study aims to compare the outcomes of contemporary suprarenal and infrarenal endografts. Methods The Targeted Vascular Module of the National Surgical Quality Improvement Project was utilized to identify patients undergoing EVAR for infrarenal aneurysm from 2011–2013. Preoperative and operative variables and 30-day outcomes were compared between suprarenal (Zenith and Endurant) and infrarenal fixation devices (Excluder). Renal complications included creatinine increase > 2 mg/dL or new dialysis, as defined by NSQIP. Multivariable regression was completed to account for patient demographics, co-morbidities, and operative characteristics. Results 3 587 patients were evaluated including 2 273 (63%) with suprarenal grafts and 1 314 (37%) with infrarenal grafts. Patients with suprarenal grafts were less commonly white (84% vs. 88%, P < 0.01) and more commonly male (83% vs. 80%, P = 0.03). There were no differences in age or comorbidities. Renal complications (1.1% vs. 0.1%, P < 0.01) and length of stay >2d (34% vs. 25%, P < 0.01) occurred more commonly after suprarenal fixation. After adjustment, suprarenal grafts had significantly higher rates of renal complications (OR: 12.0, 95% CI: 1.6–91) and length of stay >2d (OR: 1.4, 95% CI: 1.2–1.7). Conclusion Overall rates of renal complications following EVAR are quite low. Patients selected for suprarenal stent grafts are at increased risk for renal complications and prolonged length of stay, which may be due to selection bias, deployment techniques, or the presence of a bare stent overlying the renal arteries. Further studies are necessary to evaluate the mechanism and duration of renal dysfunction and important long-term outcomes of interest.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Renal Complications between Endografts with Suprarenal and Infrarenal Fixation

Zettervall

Soden

Deery

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…There is concern that the suprarenal stent proximal fixation across the renal artery ostia could result in renal dysfunction. However, there are controversial reports in literature and in a recent systematic review regarding suprarenal versus infrarenal stent graft fixation location did not show a significant difference in postoperative renal complications (23). Similarly, endograft coverage and sacrifice of accessory renal arteries may occur, but this has not been shown to correlate with increased renal dysfunction despite correlation with increased renal infarction volume (20,24,25).…”

Section: Renal Arterymentioning

confidence: 97%

Repair of abdominal aortic aneurysms: preoperative imaging and evaluation

Pisimisis

Sheth

2018

Cardiovasc. Diagn. Ther.

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Imaging is a critical component of the pre-procedure evaluation and planning of endovascular aneurysm repair (EVAR). Imaging is the mainstay for proper assessment of procedural candidacy, relevant vascular anatomy, device selection, and surgical approach. Computed tomography angiography (CTA) has long been considered the preferred modality for pre-operative imaging and evaluation prior to EVAR.Recently, advances in image quality and software technology have further enhanced the proceduralist's ability to plan and perform EVAR. In this review, we highlight the current state of the art to provide interventionalists a contemporary assessment of the available tools for pre-operative imaging and evaluation prior to EVAR.

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“…In a retrospective case-matched analysis of 726 patients, EVAR (with suprarenal fixation EVAR 9 infrarenal fixation) led to greater decrease in eGFR than open aortic repair [60]. However, a meta-analysis (n = 4,474) showed no difference between suprarenal fixation versus infra-renal fixation devices [61]. In a retrospective study of 1,756 patients, EVAR was shown to have a less deleterious effect on renal function than open surgery in patients with pre-operative renal dysfunction [62].…”

Section: Renal Functionmentioning

confidence: 99%

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

O’Mara

Bersin

2016

Curr Treat Options Cardio Med

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Endovascular aneurysm repair (EVAR) has become the predominant method of treatment for abdominal aortic aneurysms (AAA). The use of conscious sedation with local anesthesia and percutaneous femoral access has further decreased the morbidity of the procedure. Current devices can more effectively manage increasingly "hostile" aneurysm necks, while chimney grafts or dedicated fenestrated stent-grafts can be used for juxta-renal disease with favorable results. However, endovascular repair does present a new set of challenges, and endoleaks remain an area of concern. While there is general consensus that type I and type III endoleaks require treatment, type II endoleaks are the topic of ongoing research and debate. Development of devices and techniques to prevent and treat endoleak continues to progress. Advances in contrast-enhanced ultrasound are reducing reliance on computed tomography for post-operative monitoring. This is an important step in this population at high risk for the development of kidney failure. Despite these many innovations, further research is needed to optimize the care of patients with AAA.

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Suprarenal versus infrarenal stent graft fixation on renal complications after endovascular aneurysm repair

Cited by 36 publications

References 38 publications

Comparison of Renal Complications between Endografts with Suprarenal and Infrarenal Fixation

Comparison of Renal Complications between Endografts with Suprarenal and Infrarenal Fixation

Repair of abdominal aortic aneurysms: preoperative imaging and evaluation

Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

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