Renal Outcomes Analyzed After Fenestrated and Branched EVAR

September 23, 2015—A study that sought to analyze immediate and long-term renal outcomes (renal function and renal events) after fenestrated (FEVAR) and branched endovascular aortic aneurysm repair (BEVAR), was published by Teresa Martin-Gonzalez, MD, et al in the European Journal of Vascular & Endovascular Surgery (EJVES, 2015;50:420–430).

The investigators concluded that FEVAR and BEVAR are durable options for the treatment of complex aortic aneurysms and are associated with low renal morbidity, without differences between devices types. They advised that the clinical impact of decreasing renal volume over time in these patients is yet to be fully understood.

As summarized in EJVES, the study included all FEVAR and BEVAR performed between October 2004 and October 2012. Postoperative acute renal failure was defined according to the RIFLE criteria. Renal volume (calculated with a three-dimensional workstation) and estimated glomerular filtration rate (GFR) (estimated with the Modification of Diet in Renal Disease [MDRD] formula) were evaluated before the procedure, before discharge, 12 months after, and yearly thereafter. 

Renal composite events included renal stent occlusion, dissection, fracture, stenosis, kink, renal stent related endoleak, and renal stent secondary intervention. All were analyzed. A time-to-event analysis was performed for renal events and secondary renal interventions.

The study was composed of 225 patients treated with FEVAR and BEVAR. Renal target vessels (n = 427) were perfused by fenestrations (n = 374), or branches (n = 53). Median follow-up was 3.1 years (2.9–3.3 y). Technical success was achieved in 95.5% of patients. 

The investigators reported that postoperative acute renal failure was seen in 64 patients (29%). Mean total renal volume and eGFR at 1-year, 2-year, and 3-year follow-up were significantly lower when compared with preoperative levels (after BEVAR and FEVAR). The decrease at 3 years was 14.8% (BEVAR, 6.7%; FEVAR, 22.2%) for total renal volume and 14.3% (BEVAR, 3.1%; FEVAR, 24.3%) for eGFR. 

The investigators reported that the freedom from renal composite events was 98.6% at 30 days and 84.5% at 5 years. The freedom from renal occlusion was 99.5% at 30 days and 94.4% at 5 years.