Endografts With Suprarenal Versus Infrarenal Fixation Compared for Renal Complications


July 6, 2017—A study comparing renal complications between endografts with suprarenal or infrarenal fixation was published by Sara L. Zettervall, MD, et al in European Journal of Vascular and Endovascular Surgery (EJVES; 2017;54:5–11).

In this study, the investigators aimed to compare the outcomes of contemporary suprarenal and infrarenal endografts. The background of the study is that there are multiple graft options available for the endovascular treatment of abdominal aortic aneurysm (EVAR), and some interventionalists hypothesize that suprarenal fixation endografts may result in higher rates of renal complications than infrarenal endografts.

As summarized in EJVES, the investigators used the Targeted Vascular Module of the National Surgical Quality Improvement Project (NSQIP) to identify patients undergoing EVAR for an infrarenal aneurysm from 2011 to 2013. Preoperative and operative variables and 30-day outcomes were compared among devices with suprarenal (Zenith [Cook Medical] and Endurant [Medtronic]) or infrarenal (Excluder [Gore & Associates]) fixation. Renal complications included creatinine level increase > 2 mg/dL or new dialysis, as defined by NSQIP. Multivariate regression was completed to account for patient demographics, comorbidities, and operative characteristics.

A total of 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 Caucasian (84% vs 88%; P < .01) and more commonly men (83% vs 80%; P = .03). There were no differences in age or comorbidities. Renal complications (1.1% vs 0.1%; P < .01) and length of hospital stay > 2 days (34% vs 25%; P < .01) occurred more commonly after suprarenal fixation than with infrarenal fixation, respectively. After adjustment, suprarenal grafts showed significantly higher rates of renal complications (odds ratio [OR], 12.0; 95% confidence interval [CI], 1.6–91) and length of hospital stay > 2 days (OR, 1.4; 95% CI, 1.2–1.7).

The investigators concluded that the overall rates of renal complications following EVAR are low and that patients selected for suprarenal stent grafts are at increased risk of renal complications and prolonged length of hospital stay, which may be caused by selection bias, deployment techniques, or the presence of a bare stent overlying the renal arteries. More studies are necessary to evaluate the mechanism and duration of renal dysfunction and important long-term outcomes of interest, advised the investigators in EJVES.


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