Impact of Accessory Renal Artery Coverage on Renal Function during Endovascular Aortic Aneurysm Repair

Abstract

Long-term outcomes of accessory renal artery (ARA) coverage after endovascular aneurysm repair (EVAR) are unknown. We analyzed the impact of ARA coverage on renal function long-term. This retrospective, monocentric study included patients treated by EVAR between 2008 and 2016. Patients with at least one ARA covered with EVAR (ARA group) were compared with patients with no covered ARA (control group). Renal function was determined by estimating the glomerular filtration rate (eGFR) and graded according to chronic kidney disease (CKD) classification stages. A total of 184 patients were included (ARA group, n=25; control group, n=159). Renal risk factors were similar in the 2 groups. Mean (±standard deviation) duration of follow-up was 41.6±25.8months. Preoperative eGFR (mL/min/1.73m2) was 68.9±17.8 in the ARA group and 72.5±17.4 in the control group (P=0.33), with a similar decline in the 2 groups during follow-up (-6.52±11.6 ARA group vs. -6.43±13.8 control group; P=0.97). At the end of the study, 8 ARA patients and 56 controls had deteriorated by one CKD stage (32% vs. 35.2%, respectively; P=0.75). Rate of renal infarction was significantly higher in the ARA group (96% vs. 1.9%; P<0.0001). In multivariate analysis, suprarenal fixation was identified as a risk factor for a decline in renal function (odds ratio=2.01 [95% confidence interval: 1.05-3.84]; P=0.04). ARA coverage after EVAR does not appear to affect renal function long-term. Suprarenal fixation led to a greater decline in renal function.