Impact Of Accessory Renal Artery Exclusion During Fenestrated Endovascular Repair For Juxtarenal Aortic Aneurysm

Abstract

Introduction - The purpose of this study is to determine the clinical impact of accessory renal artery coverage on the renal function after fenestrated endovascular repair (f-EVAR) for juxtarenal aortic aneurysm. Methods - Between January 2005 and December 2016, 77 patients had f-EVAR for juxtarenal aneurysm with the Cook Zenith fenestrated endograft. Retrospectively, pre-operative CT was reviewed for the number and the diameter of accessory renal artery and post-operative CT was analyzed for accessory renal artery thrombosis and renal infarct. Patients with at least one renal accessory artery covered by the endograft were in group Acc and patients without renal accessory artery covered were in group NoAcc. Immediate postoperative renal insufficiency was compared between both groups. During follow-up, significant renal dysfunction was defined by a 25% or more deterioration of estimated glomerular filtration rate asses on two or more successive control. Results - Sixty-one patients (79%) were included in group NoAcc and sixteen patients (21%) were included in group Acc, 21 accessory renal arteries were covered, 8 had a diameter ≥ 3mm and 4 patients had 2 renal accessory arteries. The demographics of the patients were similar, the median pre-operative serum creatinine levels (group NoAcc vs group Acc) were 92 mmol/L (range 49-156 mmol/L) and 99 mmol/L (range 72-163 mmol/L) (p = .692), median aneurysm diameters were 54 mm (range 50-89 mm) and 55.5 mm (range 52 - 63 mm) (p=.138), respectively. Median quantity of contrast medium was 204 ml (range 67 – 540) and 230 ml (range 120 – 450) (p=.526). On post f-EVAR CT, 4 patients had an identified renal infarct, all of them were secondary to intentional coverage of an accessory renal artery, no immediate renal stent thrombosis was observed. New onset of postoperative renal insufficiency was detected in 8% versus 12% (p=.630), mortality was 2% vs 6% (p=.374), in NoAcc and Acc groups, respectively. At 3 years, patient survival was 89% vs 84% (p=.358), freedom from renal function deterioration was 78% vs 74% (p=.702). Conclusion - This retrospective analysis found no immediate postoperative renal failure or late renal function deterioration resulting from accessory renal arteries coverage during f-EVAR for Juxta renal aneurysms.