Endovascular abdominal aortic repair may involve incorporation of renal arteries. Revascularization after intentional or unintentional renal artery coverage is not always technically successful and loss of a single renal artery may result in the need for postoperative dialysis. To compare outcomes after endovascular aneurysm repair (EVAR) stratified by renal artery involvement (RAI).Patients in the Vascular Quality Initiative (VQI) registry were analyzed (2009-2018). Exclusion criteria were preoperative dialysis, missing RAI variable, and repair above the superior mesenteric artery. Repair type cohorts were defined as: 1) no RAI (NRAI), 2) RAI with revascularization (RAI-R), 3) RAI and no revascularization (RAI-NR). A sensitivity analysis was performed by excluding ruptured presentation. The primary outcome was postoperative dialysis. Secondary outcomes were 30-day mortality, dialysis at follow-up, postoperative renal function, and 2-year survival. Multivariate analysis was used to determine independent predictors of postoperative dialysis. Two-year survival analysis was performed using Kaplan-Meier log-rank test.Of 54,020 patients in the EVAR and TEVAR/complex EVAR modules in the VQI, 25,724 met criteria for inclusion (24,879 NRAI, 733 RAI-R, 112 RAI-NR). Demographics and comorbidities were similar between groups. RAI-NR were more frequently ruptured or symptomatic. Postoperative dialysis was higher in RAI-NR (0.7% NRAI vs. 2.2% RAI-R vs. 17% RAI-NR, p<.0001) as were 30-day mortality and dialysis at follow-up. On multivariate analysis, RAI-R (OR 2.2, p=.03) and RAI-NR (OR 5.9, p<.0001) were independent predictors of postoperative dialysis and remained so after excluding ruptures: RAI-R (OR 3, p=.003) and RAI-NR (OR 22.3, p<.0001). Other independent predictors of postoperative dialysis were worse preoperative renal function symptomatic presentation, any preoperative/intraoperative blood transfusion, and larger blood loss (=200 mL). Excluding ruptures, overall survival at 2-years on Kaplan-Meier was lower in RAI-NR (92% NRAI vs. 89% RAI-R vs. 80% RAI-NR, p=.004).RAI is highly predictive of the need for postoperative and permanent dialysis following EVAR. RAI without revascularization is associated with lower overall survival. These risks should be taken into consideration with planning and performing EVAR and should be weighed against the risks of open repair when considering treatment options.
View details for DOI 10.1016/j.jvs.2021.02.033
View details for PubMedID 33684468