Understanding the Impact of Fenestrated Aortic Repair on Medium and Long-term Renal Function; A UK Tertiary Centre Experience

Abstract

Introduction: Renal function, its decline and the presence of acute kidney injury (AKI) is associated with poor cardiovascular outcomes and it maybe a common phenomenon in standard Endovascular Aneurysm repair (EVAR). Data is conflicting as to the impact of Fenestrated EVAR on renal function. This study aimed understand the impact of FEVAR on renal function at a UK tertiary centre. Methods: A prospectively populated database of FEVAR's performed between 2010 and 2018 were analysed. Creatinine, reciprocal of creatinine (as per the ASTRAD Trial) and eGFR (calculated by the CKD-EPI and MDRD formulae) were assessed. Regression analysis was performed to identify correlation variables. Results: 133 patients treated with FEVAR were included. Median follow-up was 22 months with a mean AAA diameter of 6.4(1.1) cm and a baseline eGFR of 68.9mL/min/1.73m2. A statistically significant 14% decline was noted at day 3 but this improved over study follow-up with an overall small decline of 10% in renal function at 22months. 5-year follow-up demonstrated a return to baseline in a subset of 60 long-term follow patients. A higher Pre-operative serum creatinine and lower haemoglobin significantly correlated with a decline in both short and long-term renal function. Independently, a larger the AAA diameter predicted a poorer the Day 3 renal function and the longer the duration of procedure the greater the decline in long-term renal function. A baseline Serum Creatinine of 94 mmolL-1 or higher predicted a AKI stage 1 at Day 3. Additionally, those at risk of developing a high Serum Creatinine (>130mmolL-1) were predicted by a baseline Serum Creatinine of 125 mmolL-1 or higher. Conclusion: Reassuringly FEVAR is associated with only a small decline in renal function. An increasing length of procedure (perhaps a surrogate for contrast volume) and size of the AAA leads to a higher post-procedural creatinine. Pre-operative renal function is important and optimization may improve renal function outcomes in the short-term. Comparisons of pre-existing renal artery disease and renal function is underway. Disclosure: Nothing to disclose