Impact of Polar Renal Artery Coverage after Fenestrated Endovascular Aortic Repair for Juxtarenal and Type IV Thoracoabdominal Aortic Aneurysms

Abstract

Fenestrated endovascular aortic repair (FEVAR) of complex aneurysm can require the coverage of polar renal artery. The aim of this study was to investigate the impact of the procedure on postoperative outcomes in patients with juxtarenal or thoracoabdominal aortic aneurysms. Patients who had FEVAR for juxtarenal or type IV thoracoabdominal aortic aneurysm were retrospectively included between January 2010 and October 2017. The estimated glomerular filtration rate (eGFR) was recorded before and at 1 day, 7 days after surgery, and at the last follow-up. The occurrence of renal infarct was analyzed on the injected computed tomography scan images. Forty-three patients deemed at high-risk for open repair underwent FEVAR; 10patients (23.3%) had polar renal artery coverage and were compared to patients without polar renal artery. The eGFR did not differ between the groups at 1 day and 7days after FEVAR (69 vs 61.6mL/mn/1.73m2, P=0.8708 and 68.4mL/mn/1.73m2 vs 68, P=0.9440, respectively). For a median follow-up of 233days, the eGFR at the latest follow-up was 38mL/mn/1.73m2 (21.8-56.3) in patients who had polar renal artery covered and 57mL/mn/1.73m2 (46.5-76) in patients without polar renal artery (P=0.0748). Patients who had polar renal artery had a higher rate of postoperative kidney renal infarct (60% vs 21.2%, P=0.0441). The proportion of vascular complications did not differ (30% vs 30.3%, P=0.9999). No endoleak related to polar renal artery coverage was observed. The 30-day postoperative mortality was 4.7%. Polar renal artery coverage during FEVAR is not associated with critical renal and vascular short-term outcomes but could impact long-term renal function.