Female Gender: A Leading Predictor of Decline in Renal Function 5 Years After Endovascular Abdominal Aortic Aneurysm Repair

Abstract

Although copious short-term data exist regarding renal function after infrarenal endovascular abdominal aortic aneurysm repair (EVAR), long-term data are sparse. We performed a single-institution retrospective review to identify the predictors of renal function 5 years after elective EVAR. All EVAR cases performed at a single institution from 2007 to 2015 were queried. Patients for whom renal function was documented 5 years postoperatively were included in present analysis. The exclusion criteria were ruptured aneurysms, mortality before 56 months, lack of follow-up, end-stage renal disease status, and concomitant renal intervention. The primary outcome was a ≥20% decrease in the glomerular filtration rate (GFR) at 5 years postoperatively. The following variables at surgery were investigated as potential predictors: age, gender, hypertension, hyperlipidemia, diabetes, coronary artery disease or prior myocardial infarction, chronic obstructive pulmonary disease, prior stroke, baseline estimated GFR <60 mL/min/1.73 m2, suprarenal fixation, infrarenal fixation, neck diameter, neck length, and number of contrast computed tomography scans. A total of 354 EVARs were identified, of which 143 met the inclusion criteria (211 were excluded). Univariate analysis revealed that female gender, hypertension, baseline renal insufficiency, larger neck diameter, and suprarenal fixation (relative to infrarenal fixation) were all predictive (P < .05) of a GFR decrease at 5 years postoperatively. Multivariate binary logistic regression analysis found female gender and baseline renal insufficiency were significant predictors (P = .02 for both) of a >20% GFR decrease at 5 years (Table). Only 2 of the 143 patients in the present study had required to dialysis at 5 years. Women and patients with baseline renal insufficiency are more vulnerable to a significant decline in renal function at 5 years after EVAR. Consistent with analogous literature, suprarenal fixation appeared moderately deleterious toward renal function. The potential benefit of avoiding suprarenal fixation in female patients with baseline renal insufficiency is worth further investigation in a more robust multicenter study.Tabled 1Table. Predictors of greater than 20% drop in GFR 5 years after EVARVariableGreater than 20% drop in GFR at 5 years (n = 32)No drop in GFR >20% at 5 Years postop (n = 111)Univariate odds ratioUnivariate P valueMultivariate odds ratio (95% CI)Multivariate P valueFemale gender28% (n = 9)13% (n = 14)2.7.0353.9 (1.2-12.3).023Male gender72% (n = 23)87% (n = 97)Mean age75.25 (SD 7.6)72.6 (SD 8.28).1.351Diabetes mellitus25% (n = 8)30% (n = 33)0.78.61.3 (0.5-3.7).552Hypertension97% (n = 31)77% (n = 85)9.4.015.0 (0.5-50.3).172Hyperlipidemia84% (n = 26)70% (n = 78)1.3.222.2 (.64-7.4).211COPD16% (n = 5)11% (n = 17)1.02.970.8 (.22-.79).733CAD or Hx of MI56% (n = 18)60% (n = 67)0.84.681.4 ( .54-3.5).497Hx of prior stroke13% (n = 5)11% (n = 12)1.52.461.5 (.31-7.3)0.61Baseline eGFR less than 6050% (n = 16)21% (n = 23)3.8.0013.0 (1.1-7.9).029Mean neck diameter, mm28.3 (SD 4.08)24.1 (SD 3.87)<.001.825Mean neck length, mm28.3 (SD 12.3)31.67 (SD 14).22.491Mean number contrast CT Scan at 5 years postop3.4 (SD 2.56)4.74 (SD 3.48).95.356Suprarenal fixation69% (n = 22)49% (n = 54)2.32.042.2 (.83-5.6).102Infrarenal fixation31% (n = 10)51% (n = 57)Nominal Variables : Chi-Squared Test for UnivariateOrdinal Variables : T-test for UnivariateMultivariate Analysis : Binary Logistic Regression Analysis Open table in a new tab