Influence of baseline kidney dysfunction on perioperative renal outcomes after endovascular aneurysm repair with suprarenal fixation
Conflicting evidence exists regarding the comparative effects of endovascular aneurysm repair (EVAR) with and without suprarenal fixation. We compare outcomes in patients treated by EVAR with baseline normal kidney function and moderate and severe chronic kidney disease. Patients with normal kidney...
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| Veröffentlicht in: | Journal of vascular surgery 2021-01, Vol.73 (1), p.92-98 |
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| creator | Pujari, Amit Ramos, Christopher R. Duwayri, Yazan Rajani, Ravi R. Jordan Jr, William D. Crawford, Robert S. Benarroch-Gampel, Jaime |
| description | Conflicting evidence exists regarding the comparative effects of endovascular aneurysm repair (EVAR) with and without suprarenal fixation. We compare outcomes in patients treated by EVAR with baseline normal kidney function and moderate and severe chronic kidney disease.
Patients with normal kidney function (glomerular filtration rate [GFR] ≥60 mL/min/1.73 m2) or moderate (GFR = 30-59 mL/min/1.73 m2) or severe (GFR 2 mg/dL without dialysis or new dialysis requirements, were analyzed within the first 30 days with results stratified by degree of kidney disease.
A total of 5534 patients underwent EVAR, with 3225 (58.3%) receiving a device using a suprarenal fixation system. Suprarenal fixation systems were less commonly used for symptomatic patients (11.0% vs 13.7%; P = .002) and patients with ruptured abdominal aortic aneurysm (4.5% vs 6.3%; P = .01). There was no difference in baseline kidney function between groups. EVAR with suprarenal fixation was associated with more renal complications (1.40% vs 0.65%; P = .008). In subgroup analysis, patients with moderate kidney dysfunction (n = 1780) had more renal complications (2.2% vs 0.8%; P = .02) with suprarenal fixation systems. No differences were seen in patients with normal kidney function (0.4% vs 0.2%; P = .32; n = 3597) or severe kidney dysfunction (14.3% vs 10.2%; P = .45; n = 157). This difference was driven mostly by postoperative elevation of creatinine concentration (0.6% vs 0.2%; P = .03) without requirements for new dialysis (0.8% vs 0.4%; P = .08). After adjustments with multivariate logistic regression models, EVAR with suprarenal fixation was associated with more renal complications (odds ratio, 2.65; 95% confidence interval, 1.32-5.34).
In our study, EVAR with suprarenal fixation devices was associated with more perioperative renal complications in patients with moderate kidney dysfunction. Long-term evaluation of these patients undergoing EVAR should be considered. |
| doi_str_mv | 10.1016/j.jvs.2020.03.062 |
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Patients with normal kidney function (glomerular filtration rate [GFR] ≥60 mL/min/1.73 m2) or moderate (GFR = 30-59 mL/min/1.73 m2) or severe (GFR <30 mL/min/1.73 m2) kidney disease who underwent EVAR (N = 5534) were identified from the American College of Surgeons National Surgical Quality Improvement Program targeted database (2011-2015). Groups were determined by the presence (Cook Zenith [Cook Medical, Bloomington, Ind] or Medtronic Endurant [Medtronic, Minneapolis, Minn]) or absence (Gore Excluder [W. L. Gore & Associates, Flagstaff, Ariz]) of a suprarenal fixation system. Postoperative renal complications, defined as rise in creatinine concentration of >2 mg/dL without dialysis or new dialysis requirements, were analyzed within the first 30 days with results stratified by degree of kidney disease.
A total of 5534 patients underwent EVAR, with 3225 (58.3%) receiving a device using a suprarenal fixation system. Suprarenal fixation systems were less commonly used for symptomatic patients (11.0% vs 13.7%; P = .002) and patients with ruptured abdominal aortic aneurysm (4.5% vs 6.3%; P = .01). There was no difference in baseline kidney function between groups. EVAR with suprarenal fixation was associated with more renal complications (1.40% vs 0.65%; P = .008). In subgroup analysis, patients with moderate kidney dysfunction (n = 1780) had more renal complications (2.2% vs 0.8%; P = .02) with suprarenal fixation systems. No differences were seen in patients with normal kidney function (0.4% vs 0.2%; P = .32; n = 3597) or severe kidney dysfunction (14.3% vs 10.2%; P = .45; n = 157). This difference was driven mostly by postoperative elevation of creatinine concentration (0.6% vs 0.2%; P = .03) without requirements for new dialysis (0.8% vs 0.4%; P = .08). After adjustments with multivariate logistic regression models, EVAR with suprarenal fixation was associated with more renal complications (odds ratio, 2.65; 95% confidence interval, 1.32-5.34).
In our study, EVAR with suprarenal fixation devices was associated with more perioperative renal complications in patients with moderate kidney dysfunction. Long-term evaluation of these patients undergoing EVAR should be considered.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2020.03.062</identifier><identifier>PMID: 32416308</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aortic Aneurysm, Abdominal - surgery ; Blood Vessel Prosthesis ; Endovascular Procedures - methods ; EVAR ; Female ; Glomerular Filtration Rate - physiology ; Humans ; Kidney - physiopathology ; Male ; NSQIP ; Postoperative Complications - physiopathology ; Prosthesis Design ; Renal function ; Renal Insufficiency - physiopathology ; Retrospective Studies ; Risk Factors ; Suprarenal fixation ; Time Factors</subject><ispartof>Journal of vascular surgery, 2021-01, Vol.73 (1), p.92-98</ispartof><rights>2020 Society for Vascular Surgery</rights><rights>Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-a44b2773389b5cc5e54036f63aab3725f9b45a4ed5dc1e14e9ed0626fe184bf93</citedby><cites>FETCH-LOGICAL-c396t-a44b2773389b5cc5e54036f63aab3725f9b45a4ed5dc1e14e9ed0626fe184bf93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521420311101$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65308</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32416308$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pujari, Amit</creatorcontrib><creatorcontrib>Ramos, Christopher R.</creatorcontrib><creatorcontrib>Duwayri, Yazan</creatorcontrib><creatorcontrib>Rajani, Ravi R.</creatorcontrib><creatorcontrib>Jordan Jr, William D.</creatorcontrib><creatorcontrib>Crawford, Robert S.</creatorcontrib><creatorcontrib>Benarroch-Gampel, Jaime</creatorcontrib><title>Influence of baseline kidney dysfunction on perioperative renal outcomes after endovascular aneurysm repair with suprarenal fixation</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Conflicting evidence exists regarding the comparative effects of endovascular aneurysm repair (EVAR) with and without suprarenal fixation. We compare outcomes in patients treated by EVAR with baseline normal kidney function and moderate and severe chronic kidney disease.
Patients with normal kidney function (glomerular filtration rate [GFR] ≥60 mL/min/1.73 m2) or moderate (GFR = 30-59 mL/min/1.73 m2) or severe (GFR <30 mL/min/1.73 m2) kidney disease who underwent EVAR (N = 5534) were identified from the American College of Surgeons National Surgical Quality Improvement Program targeted database (2011-2015). Groups were determined by the presence (Cook Zenith [Cook Medical, Bloomington, Ind] or Medtronic Endurant [Medtronic, Minneapolis, Minn]) or absence (Gore Excluder [W. L. Gore & Associates, Flagstaff, Ariz]) of a suprarenal fixation system. Postoperative renal complications, defined as rise in creatinine concentration of >2 mg/dL without dialysis or new dialysis requirements, were analyzed within the first 30 days with results stratified by degree of kidney disease.
A total of 5534 patients underwent EVAR, with 3225 (58.3%) receiving a device using a suprarenal fixation system. Suprarenal fixation systems were less commonly used for symptomatic patients (11.0% vs 13.7%; P = .002) and patients with ruptured abdominal aortic aneurysm (4.5% vs 6.3%; P = .01). There was no difference in baseline kidney function between groups. EVAR with suprarenal fixation was associated with more renal complications (1.40% vs 0.65%; P = .008). In subgroup analysis, patients with moderate kidney dysfunction (n = 1780) had more renal complications (2.2% vs 0.8%; P = .02) with suprarenal fixation systems. No differences were seen in patients with normal kidney function (0.4% vs 0.2%; P = .32; n = 3597) or severe kidney dysfunction (14.3% vs 10.2%; P = .45; n = 157). This difference was driven mostly by postoperative elevation of creatinine concentration (0.6% vs 0.2%; P = .03) without requirements for new dialysis (0.8% vs 0.4%; P = .08). After adjustments with multivariate logistic regression models, EVAR with suprarenal fixation was associated with more renal complications (odds ratio, 2.65; 95% confidence interval, 1.32-5.34).
In our study, EVAR with suprarenal fixation devices was associated with more perioperative renal complications in patients with moderate kidney dysfunction. Long-term evaluation of these patients undergoing EVAR should be considered.</description><subject>Aged</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Blood Vessel Prosthesis</subject><subject>Endovascular Procedures - methods</subject><subject>EVAR</subject><subject>Female</subject><subject>Glomerular Filtration Rate - physiology</subject><subject>Humans</subject><subject>Kidney - physiopathology</subject><subject>Male</subject><subject>NSQIP</subject><subject>Postoperative Complications - physiopathology</subject><subject>Prosthesis Design</subject><subject>Renal function</subject><subject>Renal Insufficiency - physiopathology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Suprarenal fixation</subject><subject>Time Factors</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1u3CAURlHVqDNN-gDZVCy7sQsG_6mrKGrSkSJlk6wRhovKxAYXzKSzz4MXa9IsIxBszvddOAhdUlJSQpvv-3J_iGVFKlISVpKm-oC2lPRt0XSk_4i2pOW0qCvKN-hzjHtCKK279hPasIrThpFui152zowJnALsDR5khNE6wE9WOzhifYwmObVY73DeMwTr8yEXewAcwMkR-7QoP0HE0iwQMDjtDzKqNMqApYMUjnHK6CxtwM92-Y1jmoM8ZY39K9fuC3Rm5Bjhy-t9jh5vfj5c_yru7m9311d3hWJ9sxSS86FqW8a6fqiVqqHmhDWmYVIOrK1q0w-8lhx0rRUFyqEHnaU0BmjHB9Ozc_Tt1DsH_ydBXMRko4JxzA_1KYqKk3V1tMsoPaEq-BgDGDEHO8lwFJSIVb7YiyxfrPIFYSLPyZmvr_VpmEC_Jf7bzsCPEwD5kwcLQURlV_faBlCL0N6-U_8P106ZDQ</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Pujari, Amit</creator><creator>Ramos, Christopher R.</creator><creator>Duwayri, Yazan</creator><creator>Rajani, Ravi R.</creator><creator>Jordan Jr, William D.</creator><creator>Crawford, Robert S.</creator><creator>Benarroch-Gampel, Jaime</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202101</creationdate><title>Influence of baseline kidney dysfunction on perioperative renal outcomes after endovascular aneurysm repair with suprarenal fixation</title><author>Pujari, Amit ; Ramos, Christopher R. ; Duwayri, Yazan ; Rajani, Ravi R. ; Jordan Jr, William D. ; Crawford, Robert S. ; Benarroch-Gampel, Jaime</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-a44b2773389b5cc5e54036f63aab3725f9b45a4ed5dc1e14e9ed0626fe184bf93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Blood Vessel Prosthesis</topic><topic>Endovascular Procedures - methods</topic><topic>EVAR</topic><topic>Female</topic><topic>Glomerular Filtration Rate - physiology</topic><topic>Humans</topic><topic>Kidney - physiopathology</topic><topic>Male</topic><topic>NSQIP</topic><topic>Postoperative Complications - physiopathology</topic><topic>Prosthesis Design</topic><topic>Renal function</topic><topic>Renal Insufficiency - physiopathology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Suprarenal fixation</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pujari, Amit</creatorcontrib><creatorcontrib>Ramos, Christopher R.</creatorcontrib><creatorcontrib>Duwayri, Yazan</creatorcontrib><creatorcontrib>Rajani, Ravi R.</creatorcontrib><creatorcontrib>Jordan Jr, William D.</creatorcontrib><creatorcontrib>Crawford, Robert S.</creatorcontrib><creatorcontrib>Benarroch-Gampel, Jaime</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pujari, Amit</au><au>Ramos, Christopher R.</au><au>Duwayri, Yazan</au><au>Rajani, Ravi R.</au><au>Jordan Jr, William D.</au><au>Crawford, Robert S.</au><au>Benarroch-Gampel, Jaime</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of baseline kidney dysfunction on perioperative renal outcomes after endovascular aneurysm repair with suprarenal fixation</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2021-01</date><risdate>2021</risdate><volume>73</volume><issue>1</issue><spage>92</spage><epage>98</epage><pages>92-98</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Conflicting evidence exists regarding the comparative effects of endovascular aneurysm repair (EVAR) with and without suprarenal fixation. We compare outcomes in patients treated by EVAR with baseline normal kidney function and moderate and severe chronic kidney disease.
Patients with normal kidney function (glomerular filtration rate [GFR] ≥60 mL/min/1.73 m2) or moderate (GFR = 30-59 mL/min/1.73 m2) or severe (GFR <30 mL/min/1.73 m2) kidney disease who underwent EVAR (N = 5534) were identified from the American College of Surgeons National Surgical Quality Improvement Program targeted database (2011-2015). Groups were determined by the presence (Cook Zenith [Cook Medical, Bloomington, Ind] or Medtronic Endurant [Medtronic, Minneapolis, Minn]) or absence (Gore Excluder [W. L. Gore & Associates, Flagstaff, Ariz]) of a suprarenal fixation system. Postoperative renal complications, defined as rise in creatinine concentration of >2 mg/dL without dialysis or new dialysis requirements, were analyzed within the first 30 days with results stratified by degree of kidney disease.
A total of 5534 patients underwent EVAR, with 3225 (58.3%) receiving a device using a suprarenal fixation system. Suprarenal fixation systems were less commonly used for symptomatic patients (11.0% vs 13.7%; P = .002) and patients with ruptured abdominal aortic aneurysm (4.5% vs 6.3%; P = .01). There was no difference in baseline kidney function between groups. EVAR with suprarenal fixation was associated with more renal complications (1.40% vs 0.65%; P = .008). In subgroup analysis, patients with moderate kidney dysfunction (n = 1780) had more renal complications (2.2% vs 0.8%; P = .02) with suprarenal fixation systems. No differences were seen in patients with normal kidney function (0.4% vs 0.2%; P = .32; n = 3597) or severe kidney dysfunction (14.3% vs 10.2%; P = .45; n = 157). This difference was driven mostly by postoperative elevation of creatinine concentration (0.6% vs 0.2%; P = .03) without requirements for new dialysis (0.8% vs 0.4%; P = .08). After adjustments with multivariate logistic regression models, EVAR with suprarenal fixation was associated with more renal complications (odds ratio, 2.65; 95% confidence interval, 1.32-5.34).
In our study, EVAR with suprarenal fixation devices was associated with more perioperative renal complications in patients with moderate kidney dysfunction. Long-term evaluation of these patients undergoing EVAR should be considered.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32416308</pmid><doi>10.1016/j.jvs.2020.03.062</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aortic Aneurysm, Abdominal - surgery Blood Vessel Prosthesis Endovascular Procedures - methods EVAR Female Glomerular Filtration Rate - physiology Humans Kidney - physiopathology Male NSQIP Postoperative Complications - physiopathology Prosthesis Design Renal function Renal Insufficiency - physiopathology Retrospective Studies Risk Factors Suprarenal fixation Time Factors |
| title | Influence of baseline kidney dysfunction on perioperative renal outcomes after endovascular aneurysm repair with suprarenal fixation |
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