Impact of Renal Function on Early and Late Survival After Endovascular Thoracoabdominal and Pararenal Aortic Aneurysm Repair

Abstract

Renal dysfunction can be a prohibitive risk for open repair of complex thoracoabdominal aortic aneurysms (TAAAs) and pararenal aneurysms (PRAs). However, the impact of renal dysfunction from branched/fenestrated aneurysm repair (B-FEVAR) on outcomes is poorly defined. The objective was to review the association of renal function with early and long-term mortality after B-FEVAR. This study reviewed the clinical data of consecutive patients enrolled in a prospective nonrandomized study to investigate B-FEVAR for PRAs and TAAAs at a single institution with 1-year follow up (2013-2017). Patients were categorized by preoperative chronic kidney disease (CKD) classification, and early and long-term mortality was assessed. During the study interval, 231 patients underwent B-FEVAR, including 80 PRAs, 89 type I to type III TAAAs, and 62 type IV TAAAs. Mean age was 74.6 years (standard deviation, 6.7 years), and 71% were male. There were 126 CKD stage 1/2 patients, 96 CKD stage 3 patients, and 9 CKD stage 4/5 patients (all with baseline creatinine concentration >2.0 mg/dL). No patients were on dialysis at time of procedure. Patients with CKD stage 4/5 had similar demographics to those with normal renal function but had slightly larger aneurysms (6.5 vs 7 cm; P = .15). Early 30-day mortality was 1.35% (n = 3) for those with CKD stage 1 to stage 3 vs 0% in CKD stage 4/5 (P = .73). Similarly, 1-year survival was similar (95% vs 88%; log-rank, P = .98) for CKD stage 1 to stage 3 patients vs CKD stage 4/5 patients, respectively. Median follow-up time was 2.6 years (interquartile range, 1.5-3.7 years). Two CKD stage 4/5 patients died in follow-up. CKD stage 4/5 patients had similar survival during follow-up (hazard ratio, 1.02; 95% confidence interval, 0.2-4.2). Although it was a small sample size for evaluation, selected patients with CKD stage 4/5 may have similar short- and long-term mortality to that of patients with normal/moderate renal dysfunction after B-FEVAR. Although it is a major contraindication to open repair, renal dysfunction may not be as prohibitive for endovascular repair in well-selected patients.