Ex-vivo Renal Artery Reconstruction with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Late Results of 67 Procedures

Abstract

s 393 of this study is to determine the true incidence and long term outcome of CIN in the optimised CKD population. Methods: Consecutive patients with stage III-V CKD, undergoing peripheral (group 1) or cardiac (group 2) angiography at a single centre regional Australian hospital between 2005 e2015 were included. Patients concurrently dialysing were excluded. All patients underwent pre procedural medical optimisation by a renal physician (intravenous hydration with normal saline, blood pressure control, withholding ACE Inhibitors, Metformin and Frusemide). Low-osmolality non-ionic contrast diluted to 1/3 strength (group 1) or 1/2 strength (group 2) was used. CIN was defined as creatinine rise of>25% from baseline within 72 hours. Primary outcomewas incidence of CIN. Secondary outcomes were mortality at 6 months, progression to dialysis and long term progression of CKD. Results: 537 patients with CKD stage III-V underwent angiography. 222 patients concurrently dialysing were excluded. Median ages (group 1 n 1⁄4 75, Group 2 n 1⁄4 76, P 1⁄4 0.25) were similar; diabetes was more prevalent in group 1 (70.5%) (group 2 1⁄4 48.4%) (P 1⁄4 0.001) and ischaemic heart disease more prevalent in group 2 (60.0%), (Group 1 1⁄4 44.3%) (P 1⁄4 0.02). Median volume of contrast used was significantly lower for group 1 (n 1⁄4 35 mls, range 2.5 e350 mls) compared to group 2 (n 1⁄4 75 mls, range 20e357) (P < 0.001). Combined incidence of CIN was 3.7%. Incidence of CIN did not differ between groups (group 1 1⁄4 4.1%, group 2 1⁄4 3.2%, P 1⁄4 0.74). No patients with CIN died within 6 months. Follow up ranged from 2e73 months. No patient with CIN progressed to higher CKD stage or dialysis. Conclusion: CIN in CKD population is multifactorial and was not related to volume of contrast used. Pre procedural optimisation of CKD patients and low osmolarity contrast agents may reduce incidence of CIN to a level comparable with the general population. CIN in CKD patients does not lead to death or long term disease progression. Ex-vivo Renal Artery Reconstruction with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Late Results of 67 Procedures B. Chavent, A. Duprey, V. Meyer-Bisch, J.N. Albertini, J.P. Favre, X. Barral, J.B. Ricco University of St Etienne Medical School, France Introduction: The objective of this study was to evaluate the long-term outcome of renal revascularization by ex-vivo renal artery reconstruction and autotransplantation for Renal Artery Branch Aneurysms (RABA) in view of preventing aneurysm rupture. Methods: From 1991 to 2014, 67 ex-vivo renal artery reconstructions with kidney autotransplantation were performed in 58 adults (mean age, 41 years) and in 9 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia. The mean diameter of the RABA was 23.4 mm (12e 45 millimetres). Fifty-seven patients were hypertensive and were given a mean of 1.7 antihypertensive drugs per day, 61 patients had normal renal function and no patient was on haemodialysis, 7 patients (10%) were operated after failure of an endovascular procedure. The mean number of renal artery branches repaired per patient was 3.5 and multiple aneurysms were treated in 15 patients (22.3%). The hypogastric artery was used in 41 patients, the saphenous vein in 18 patients, the superficial femoral artery in 5 patients and a combination of different materials in 3 patients. Outcomes consisted in primary patency rates, antihypertensive medication requirements, renal function and mortality. Late graft patency, renal size, and cortical thickness were analyzed by yearly renal duplex ultrasound examinations. Results: One in hospital death (1.5%) occurred in a patient having undergone complex emergent aortic and renal reconstruction. Other perioperative complications included 4 bypass occlusions and one reoperation for bleeding. During a mean follow up of 9 years, 4 patients (6%) were lost to follow up. No other bypass occlusion occurred, while two bypasses required a percutaneous angioplasty. Primary patency and primary assisted patency were respectively 90% and 92.5% at 9 years. Survival was 94% at 9 years. Among the 57 hypertensive patients, 20 (35%) were cured and 14 (25%) were improved at 9 years with a significant reduction of antihypertensive medications (p < .05). Late renal function was preserved as measured by no change in all but 2 patients in estimated glomerular filtration rate compared with pre-intervention values. In addition, there was no difference in treated kidney size on follow up compared with pre-operative measurements. Conclusion: Ex-vivo renal artery reconstruction for complex renal artery branch aneurysms suppress the risk of rupture, confers a benefit in blood pressure and preserves renal function. Predicting Post-operative Delirium after Vascular Surgical Procedures.