Author + information
- Jung–Woo Son,
- Young–Guk Ko,
- Dong–Ho Shin,
- Jung–Sun Kim,
- Byeong–Keuk Kim,
- Myeong–Ki Hong,
- Yang Soo Jang and
- Donghoon Choi
Endovascular aneurysm repair (EVAR) has been well–accepted for patients with abdominal aortic aneurysm (AAA) due to lower morbidity and mortality rates compared with surgical repair. Renal function deterioration after EVAR is an important issue. However, there have been little data comparing renal function after surgical treatment and EVAR in patient with chronic renal failure (CRF). We compared renal function after EVAR and surgical repair in patients with AAA and combined CRF.
From the retrospective cohort of 313 consecutive patients that underwent EVAR or surgery from December 2005 to May 2012, a total of 98 patients (EVAR = 69, Surgery = 29) were enrolled. Inclusion criteria were patient with infrarenal AAA and estimated glomerular filtration rate (eGFR) < 60 mL/min. Combined aortic dissection, thoracic aortic aneurysm, acute aortic rupture or end stage renal failure requiring dialysis was excluded. The primary endpoint was impairment of renal function (%ΔeGFR < −20%) at 1month. The secondary end point was major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction, cerebrovascular accident, hospitalization due to heart failure or renal failure and requirement of dialysis.
Baseline characteristics including eGFR were similar between the two groups. Percent change in eGFR (%ΔeGFR) at 1 month was −7.6 ± 33.1% for surgery and 2.9 ± 22.9% for EVAR (p=0.131). Impairment of renal function (%ΔeGFR < −20%) at 1month follow–up was observed in 39.3% of the surgery group and in 11.9% of the EVAR group (p=0.004). On univariate and multivariate analysis, surgery was an independent risk factor for impaired renal function (Univariate, OR= 4.772, p=0.004; Multivariate, OR=7.92, p=0.001). During the follow–up period of 21.8 ± 22.0 months, MACE did not differ between the two groups. However, there was a trend toward higher incidence of MACE with surgical repair than with EVAR (24.1% vs. 11.6%, p=0.105).
Surgical repair of AAA was associated more frequently with impairment of renal function in patients with CRF than EVAR. Therefore, EVAR can be favored in patients with AAA and combined CRF, if anatomic criteria are appropriate.
West, Room 2009
Sunday, March 10, 2013, 8:00 a.m.–8:10 a.m.
Session Title: Endovascular Intervention and Renal Denervation
Abstract Category: 41. TCT@ACC–i2: Carotid, Neurovascular, and Endovascular Intervention
Presentation Number: 2905–1
- 2013 American College of Cardiology Foundation