Study Evaluates Impact of Fenestrated EVAR on Renal Function

September 14, 2015—In a study of the impact of fenestrated endovascular aneurysm repair (FEVAR) on renal function, Athanasios N. Saratzis, MD, et al concluded that FEVAR has a significant perioperative impact on renal function, but 1-year results are similar to open aneurysm repair (OAR). Relevant studies should be conducted to assess whether FEVAR patients may benefit from targeted strategies to prevent acute kidney injury (AKI), advised the investigators. The study is available online ahead of print in the Journal of Endovascular Therapy (JEVT).

As summarized in JEVT, the investigators conducted a case-controlled study involving 58 patients (mean age, 75 ± 7 years; 51 men) who underwent elective FEVAR for a juxtarenal or short-necked abdominal aortic aneurysm (AAA) matched on age, sex, smoking, diabetes, and baseline estimated glomerular filtration rate (eGFR). These patients were compared to a contemporaneous group undergoing OAR for the same indications. The two groups were compared for perioperative incidence of AKI and levels of eGFR at 30 days and 1 year. A systematic literature review was performed to identify studies that had used eGFR as renal outcome after FEVAR; the pooled data were meta-analyzed using an eGFR drop > 30% at 1 month and the latest follow-up as endpoints. Results are reported as the pooled proportion and 95% confidence interval (CI).

The investigators found that the incidence of AKI after FEVAR was 28% compared to 10% after OAR. The mean eGFR dropped from 78 ± 8 to 74 ± 9 mL/min/1.73 m² at 30 days after FEVAR compared to a change from 79 ± 8 to 80 ± 16 mL/min/1.73 m² after OAR. However, the absolute drop in eGFR between FEVAR and OAR at 1 year was similar (7 mL/min/1.73 m²); at 1 year, 7% of the FEVAR patients had an eGFR drop > 30% compared with none for OAR.

The systematic literature review identified eGFR outcomes for 193 FEVAR patients. Combining these patients with the 58 from the cohort study, the pooled proportions of eGFR drop > 30% were 20% (95% CI, 9% to 39%) at 30 days and 8% (95% CI, 0.5% to 13%) at the end of follow-up, reported the investigators in JEVT.