The impact of aortic endografts on renal function
To determine the impact on late postoperative renal function of suprarenal and infrarenal fixation of endografts used to treat infrarenal abdominal aortic aneurysm (AAA). Retrospective analysis of 277 patients treated from 2000 to 2003 with three different endografts at two clinical centers. Five pa...
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| Veröffentlicht in: | Journal of vascular surgery 2005-06, Vol.41 (6), p.926-930 |
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| creator | Alsac, Jean-Marc Zarins, Christopher K. Heikkinen, Maarit A. Karwowski, John Arko, Frank R. Desgranges, Pascal Roudot-Thoraval, Françoise Becquemin, Jean-Pierre |
| description | To determine the impact on late postoperative renal function of suprarenal and infrarenal fixation of endografts used to treat infrarenal abdominal aortic aneurysm (AAA).
Retrospective analysis of 277 patients treated from 2000 to 2003 with three different endografts at two clinical centers. Five patients on dialysis for preoperative chronic renal failure were excluded. Group IF of 135 patients treated with an infrarenal device (Medtronic AneuRx) was compared with group SF of 137 patients treated with a suprarenal device (106 Cook Zenith and 31 Medtronic Talent). Renal function was evaluated by calculating preoperative and latest postoperative creatinine clearance (CrCl) using the Cockcroft formula. Patients who developed a >20% decrease in CrCl were considered to have significantly impaired renal function.
There were no significant differences in patient age, sex, aneurysm size, preoperative risk factors, dose of intra- and postoperative contrast, or baseline CrCl (IF: 69.3 mL/min, SF: 71.7 mL/min,
P = .4). Follow-up time of 12.2 months was the same in both groups. CrCl decreased significantly during the follow-up period in both groups (IF: 69.3 mL/min to 61.7 mL/min,
P < .01; SF: 71.7 mL/min to 64.9 mL/min,
P < .03). Postoperative CrCl (IF: 61.7 mL/min, SF: 64.9 mL/min,
P = .3), and the rate of CrCl decrease during the follow-up period (IF: −10.9%, SF: −9.5%,
P = .2) was not different between the two groups. The number of patients with a >20% decrease in CrCl was not different between the two groups (IF: n = 35 [25.9%], SF: n = 41 [29.9%],
P = .46). However, the magnitude of decrease in CrCl in patients with renal impairment was greater in patients treated with suprarenal fixation endografts (SF: −39%) compared with those treated with infrarenal endografts (IF: −31%,
P = .005). This greater degree of renal impairment was not due to identifiable differences in preoperative risk factors, age, or baseline CrCl. No patients in these series required dialysis.
Regardless the type of endograft used, there is a 10% decrease in CrCl in the first year after endovascular aneurysm repair. Suprarenal fixation does not seem to increase the likelihood of postoperative renal impairment. Decline in renal function over time after endovascular aortic repair is probably due to multiple factors, and measures known to be effective in protecting kidneys should be considered for these patients. Long-term follow-up with measurement of CrCl, along with renal imaging and regular b |
| doi_str_mv | 10.1016/j.jvs.2005.02.024 |
| format | Article |
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Retrospective analysis of 277 patients treated from 2000 to 2003 with three different endografts at two clinical centers. Five patients on dialysis for preoperative chronic renal failure were excluded. Group IF of 135 patients treated with an infrarenal device (Medtronic AneuRx) was compared with group SF of 137 patients treated with a suprarenal device (106 Cook Zenith and 31 Medtronic Talent). Renal function was evaluated by calculating preoperative and latest postoperative creatinine clearance (CrCl) using the Cockcroft formula. Patients who developed a >20% decrease in CrCl were considered to have significantly impaired renal function.
There were no significant differences in patient age, sex, aneurysm size, preoperative risk factors, dose of intra- and postoperative contrast, or baseline CrCl (IF: 69.3 mL/min, SF: 71.7 mL/min,
P = .4). Follow-up time of 12.2 months was the same in both groups. CrCl decreased significantly during the follow-up period in both groups (IF: 69.3 mL/min to 61.7 mL/min,
P < .01; SF: 71.7 mL/min to 64.9 mL/min,
P < .03). Postoperative CrCl (IF: 61.7 mL/min, SF: 64.9 mL/min,
P = .3), and the rate of CrCl decrease during the follow-up period (IF: −10.9%, SF: −9.5%,
P = .2) was not different between the two groups. The number of patients with a >20% decrease in CrCl was not different between the two groups (IF: n = 35 [25.9%], SF: n = 41 [29.9%],
P = .46). However, the magnitude of decrease in CrCl in patients with renal impairment was greater in patients treated with suprarenal fixation endografts (SF: −39%) compared with those treated with infrarenal endografts (IF: −31%,
P = .005). This greater degree of renal impairment was not due to identifiable differences in preoperative risk factors, age, or baseline CrCl. No patients in these series required dialysis.
Regardless the type of endograft used, there is a 10% decrease in CrCl in the first year after endovascular aneurysm repair. Suprarenal fixation does not seem to increase the likelihood of postoperative renal impairment. Decline in renal function over time after endovascular aortic repair is probably due to multiple factors, and measures known to be effective in protecting kidneys should be considered for these patients. Long-term follow-up with measurement of CrCl, along with renal imaging and regular blood pressure measurements, should be performed to detect possible late renal dysfunction. Prospective studies comparing suprarenal versus infrarenal fixation are needed to confirm those results.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2005.02.024</identifier><identifier>PMID: 15944586</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - physiopathology ; Aortic Aneurysm, Abdominal - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Vessel Prosthesis Implantation - methods ; Cardiology. Vascular system ; Creatinine - urine ; Diseases of the aorta ; Female ; Humans ; Kidney - physiopathology ; Kidney Function Tests ; Life Tables ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Postoperative Period ; Renovascular diseases ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>Journal of vascular surgery, 2005-06, Vol.41 (6), p.926-930</ispartof><rights>2005 The Society for Vascular Surgery</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c490t-edc8860874579fe447611bce9255b4b345bec551a0d65474c4f738ad434eb6483</citedby><cites>FETCH-LOGICAL-c490t-edc8860874579fe447611bce9255b4b345bec551a0d65474c4f738ad434eb6483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521405002405$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16921273$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15944586$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alsac, Jean-Marc</creatorcontrib><creatorcontrib>Zarins, Christopher K.</creatorcontrib><creatorcontrib>Heikkinen, Maarit A.</creatorcontrib><creatorcontrib>Karwowski, John</creatorcontrib><creatorcontrib>Arko, Frank R.</creatorcontrib><creatorcontrib>Desgranges, Pascal</creatorcontrib><creatorcontrib>Roudot-Thoraval, Françoise</creatorcontrib><creatorcontrib>Becquemin, Jean-Pierre</creatorcontrib><title>The impact of aortic endografts on renal function</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>To determine the impact on late postoperative renal function of suprarenal and infrarenal fixation of endografts used to treat infrarenal abdominal aortic aneurysm (AAA).
Retrospective analysis of 277 patients treated from 2000 to 2003 with three different endografts at two clinical centers. Five patients on dialysis for preoperative chronic renal failure were excluded. Group IF of 135 patients treated with an infrarenal device (Medtronic AneuRx) was compared with group SF of 137 patients treated with a suprarenal device (106 Cook Zenith and 31 Medtronic Talent). Renal function was evaluated by calculating preoperative and latest postoperative creatinine clearance (CrCl) using the Cockcroft formula. Patients who developed a >20% decrease in CrCl were considered to have significantly impaired renal function.
There were no significant differences in patient age, sex, aneurysm size, preoperative risk factors, dose of intra- and postoperative contrast, or baseline CrCl (IF: 69.3 mL/min, SF: 71.7 mL/min,
P = .4). Follow-up time of 12.2 months was the same in both groups. CrCl decreased significantly during the follow-up period in both groups (IF: 69.3 mL/min to 61.7 mL/min,
P < .01; SF: 71.7 mL/min to 64.9 mL/min,
P < .03). Postoperative CrCl (IF: 61.7 mL/min, SF: 64.9 mL/min,
P = .3), and the rate of CrCl decrease during the follow-up period (IF: −10.9%, SF: −9.5%,
P = .2) was not different between the two groups. The number of patients with a >20% decrease in CrCl was not different between the two groups (IF: n = 35 [25.9%], SF: n = 41 [29.9%],
P = .46). However, the magnitude of decrease in CrCl in patients with renal impairment was greater in patients treated with suprarenal fixation endografts (SF: −39%) compared with those treated with infrarenal endografts (IF: −31%,
P = .005). This greater degree of renal impairment was not due to identifiable differences in preoperative risk factors, age, or baseline CrCl. No patients in these series required dialysis.
Regardless the type of endograft used, there is a 10% decrease in CrCl in the first year after endovascular aneurysm repair. Suprarenal fixation does not seem to increase the likelihood of postoperative renal impairment. Decline in renal function over time after endovascular aortic repair is probably due to multiple factors, and measures known to be effective in protecting kidneys should be considered for these patients. Long-term follow-up with measurement of CrCl, along with renal imaging and regular blood pressure measurements, should be performed to detect possible late renal dysfunction. Prospective studies comparing suprarenal versus infrarenal fixation are needed to confirm those results.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - physiopathology</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Vessel Prosthesis Implantation - methods</subject><subject>Cardiology. Vascular system</subject><subject>Creatinine - urine</subject><subject>Diseases of the aorta</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney - physiopathology</subject><subject>Kidney Function Tests</subject><subject>Life Tables</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Postoperative Period</subject><subject>Renovascular diseases</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtLxDAUhYMozvj4AW6kG911zG1vkgZXIr5gwI2uQ5reaoZOMybtgP_eygy4Ew7czXcOl4-xC-AL4CBvVovVNi0KzsWCF1PwgM2Ba5XLiutDNucKIRcF4IydpLTiHEBU6pjNQGhEUck5g7dPyvx6Y92QhTazIQ7eZdQ34SPadkhZ6LNIve2yduzd4EN_xo5a2yU6399T9v748Hb_nC9fn17u75a5Q82HnBpXVZJXCoXSLSEqCVA70oUQNdYlipqcEGB5IwUqdNiqsrINlki1xKo8Zde73U0MXyOlwax9ctR1tqcwJiOVBo26mEDYgS6GlCK1ZhP92sZvA9z8ejIrM3kyv54ML6bg1Lncj4_1mpq_xl7MBFztAZuc7dpoe-fTHyd1AYUqJ-52x9GkYuspmuQ89Y4aH8kNpgn-nzd-AAoog8o</recordid><startdate>20050601</startdate><enddate>20050601</enddate><creator>Alsac, Jean-Marc</creator><creator>Zarins, Christopher K.</creator><creator>Heikkinen, Maarit A.</creator><creator>Karwowski, John</creator><creator>Arko, Frank R.</creator><creator>Desgranges, Pascal</creator><creator>Roudot-Thoraval, Françoise</creator><creator>Becquemin, Jean-Pierre</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><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>20050601</creationdate><title>The impact of aortic endografts on renal function</title><author>Alsac, Jean-Marc ; Zarins, Christopher K. ; Heikkinen, Maarit A. ; Karwowski, John ; Arko, Frank R. ; Desgranges, Pascal ; Roudot-Thoraval, Françoise ; Becquemin, Jean-Pierre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c490t-edc8860874579fe447611bce9255b4b345bec551a0d65474c4f738ad434eb6483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - physiopathology</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Vessel Prosthesis Implantation - methods</topic><topic>Cardiology. Vascular system</topic><topic>Creatinine - urine</topic><topic>Diseases of the aorta</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney - physiopathology</topic><topic>Kidney Function Tests</topic><topic>Life Tables</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Postoperative Period</topic><topic>Renovascular diseases</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alsac, Jean-Marc</creatorcontrib><creatorcontrib>Zarins, Christopher K.</creatorcontrib><creatorcontrib>Heikkinen, Maarit A.</creatorcontrib><creatorcontrib>Karwowski, John</creatorcontrib><creatorcontrib>Arko, Frank R.</creatorcontrib><creatorcontrib>Desgranges, Pascal</creatorcontrib><creatorcontrib>Roudot-Thoraval, Françoise</creatorcontrib><creatorcontrib>Becquemin, Jean-Pierre</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><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>Alsac, Jean-Marc</au><au>Zarins, Christopher K.</au><au>Heikkinen, Maarit A.</au><au>Karwowski, John</au><au>Arko, Frank R.</au><au>Desgranges, Pascal</au><au>Roudot-Thoraval, Françoise</au><au>Becquemin, Jean-Pierre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of aortic endografts on renal function</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2005-06-01</date><risdate>2005</risdate><volume>41</volume><issue>6</issue><spage>926</spage><epage>930</epage><pages>926-930</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>To determine the impact on late postoperative renal function of suprarenal and infrarenal fixation of endografts used to treat infrarenal abdominal aortic aneurysm (AAA).
Retrospective analysis of 277 patients treated from 2000 to 2003 with three different endografts at two clinical centers. Five patients on dialysis for preoperative chronic renal failure were excluded. Group IF of 135 patients treated with an infrarenal device (Medtronic AneuRx) was compared with group SF of 137 patients treated with a suprarenal device (106 Cook Zenith and 31 Medtronic Talent). Renal function was evaluated by calculating preoperative and latest postoperative creatinine clearance (CrCl) using the Cockcroft formula. Patients who developed a >20% decrease in CrCl were considered to have significantly impaired renal function.
There were no significant differences in patient age, sex, aneurysm size, preoperative risk factors, dose of intra- and postoperative contrast, or baseline CrCl (IF: 69.3 mL/min, SF: 71.7 mL/min,
P = .4). Follow-up time of 12.2 months was the same in both groups. CrCl decreased significantly during the follow-up period in both groups (IF: 69.3 mL/min to 61.7 mL/min,
P < .01; SF: 71.7 mL/min to 64.9 mL/min,
P < .03). Postoperative CrCl (IF: 61.7 mL/min, SF: 64.9 mL/min,
P = .3), and the rate of CrCl decrease during the follow-up period (IF: −10.9%, SF: −9.5%,
P = .2) was not different between the two groups. The number of patients with a >20% decrease in CrCl was not different between the two groups (IF: n = 35 [25.9%], SF: n = 41 [29.9%],
P = .46). However, the magnitude of decrease in CrCl in patients with renal impairment was greater in patients treated with suprarenal fixation endografts (SF: −39%) compared with those treated with infrarenal endografts (IF: −31%,
P = .005). This greater degree of renal impairment was not due to identifiable differences in preoperative risk factors, age, or baseline CrCl. No patients in these series required dialysis.
Regardless the type of endograft used, there is a 10% decrease in CrCl in the first year after endovascular aneurysm repair. Suprarenal fixation does not seem to increase the likelihood of postoperative renal impairment. Decline in renal function over time after endovascular aortic repair is probably due to multiple factors, and measures known to be effective in protecting kidneys should be considered for these patients. Long-term follow-up with measurement of CrCl, along with renal imaging and regular blood pressure measurements, should be performed to detect possible late renal dysfunction. Prospective studies comparing suprarenal versus infrarenal fixation are needed to confirm those results.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>15944586</pmid><doi>10.1016/j.jvs.2005.02.024</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Aneurysm, Abdominal - physiopathology Aortic Aneurysm, Abdominal - surgery Biological and medical sciences Blood and lymphatic vessels Blood Vessel Prosthesis Implantation - methods Cardiology. Vascular system Creatinine - urine Diseases of the aorta Female Humans Kidney - physiopathology Kidney Function Tests Life Tables Logistic Models Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Postoperative Period Renovascular diseases Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | The impact of aortic endografts on renal function |
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