Long-Term Results after Accessory Renal Artery Coverage during Endovascular Aortic Aneurysm Repair

Abstract

Current information regarding coverage of accessory renal arteries (ARA) during endovascular aneurysm repair (EVAR) is based on small case series with limited follow-up. This study evaluates the midterm outcomes of ARA coverage in a large contemporary cohort. Consecutive EVAR data from January 2004 to August 2010 was collected in a prospective database at a university hospital. Patient and aneurysm-related characteristics, imaging studies, and ARA coverage vs preservation were analyzed. Volumetric analysis of 3-D reconstruction computed tomography (CT) scans was used to assess renal infarction volume extent. Long-term renal function and overall technical success of aneurysm exclusion was compared. A cohort of 426 EVARs was identified. ARAs were present in 69 patients with a mean follow-up of 27 months (range, 1-60 months). At least one ARA was covered in 40 patients; 29 patients had intentional ARA preservation. Patient and anatomic characteristics were similar between groups (Table). Renal infarctions occurred in 84% of kidneys with covered ARAs. There was no significant deterioration in long-term glomerular filtration rate (GFR) when compared to patients in the control group. No difference in the rate of endoleak, secondary procedures, or the requirement for antihypertensive medications was found.TablePatient and anatomic characteristicsARA coverage (n = 40)ARA preservation (n = 29)P valueARA diameter (mm)2.93 ± 0.142.95 ± 0.11.7Infarction volume (% of ipsilateral kidney)12.1 ± 1.30.5 ± 0.5< .0001Early endoleak (%)32.537.9.7Late endoleak (%)15.07.0.5Secondary procedures (%)15.017.21.0Change in GFR at last follow-up (mL/minutes)−4.3 ± 2.9−0.7 ± 3.3.4Antihypertensive agents (n)1.7 ± 0.21.8 ± 0.2.6ARA, Accessory renal arteries; GFR, glomerular filtration rate. Open table in a new tab ARA, Accessory renal arteries; GFR, glomerular filtration rate. This study is the largest to date with the longest follow-up relating to ARA coverage. Contrary to previous reports, renal infarction after ARA coverage is common. Nevertheless, coverage is well tolerated based upon preservation of renal function without additional morbidity. These results support the long-term safety of ARA coverage for EVAR when necessary.