Abstract

OBJECTIVES: To report renal outcomes including long-term patency, secondary interventions, and related renal function following fenestrated endovascular aortic repair (fEVAR).MATERIALS AND METHODS: Single center retrospective review of patients undergoing fEVAR between 2012-2018 using the Cook-ZFEN device. Renal stent complications, defined as any stenosis, occlusion, kink, renal stent related endoleak, and reinterventions were tabulated. Estimated glomerular filtration rate (GFR) was estimated using the MDRD formula.RESULTS: During the study period, 114 patients underwent elective fEVAR. Of 329 total target vessels, 193 renal arteries were stented (133 Atrium iCAST, 60 Gore VBX). Technical success was achieved in 97.4% and the mean follow-up was 23.3 months. 17 renal complications occurred in 14 patients (12.3%), including 4 occlusions, 9 stenosis, 3 dislocations and 1 type 3 endoleak. All stent complications underwent endovascular reintervention with a median hospital stay of 1 day (0-10) and a technical success of 94.2%. One patient suffered renal hemorrhage that warranted embolization. Patients with occlusion were treated the day of diagnosis, and mean time from diagnosis to intervention for stenosis was 21.5 days. Estimated primary patency was 92.1 % and 81.5% at 24 and 48 months respectively. On multivariate analysis, larger native renal artery diameter was the only independent protective factor against patency loss (HR 0.23(0.09-0.59)). Secondary patency at latest follow-up was 99.4%. Mean eGFR was not significantly different at latest follow-up between patients with renal complications versus those without (43.75 vs 55.58 mL/min/1.73m2, p=.09). Comparing patients with and without renal stent complications, 81.4% and 72.7% of patients had stable or improved renal disease by CKD staging compared to baseline (P=.51).CONCLUSIONS: fEVAR is a durable option for the treatment of juxtarenal aortic aneurysms and is associated with excellent secondary patency. Renal stent complications have no significant impact on renal function, but smaller native renal arteries are at higher risk of stent graft complications.

View details for DOI 10.1016/j.avsg.2020.10.020

View details for PubMedID 33249133