THE INFLUENCE OF NECK THROMBUS AND TYPE OF ENDOPROTHESIS USED IN THE DEVELOPMENT OF ACUTE RENAL INJURY AFTER EVAR
Introdution: Aneurysm neck morphology, in particular the presence of thrombus, may limit EVAR.
Objetives: Study whether the presence of neck thrombus and type of endoprothesis used (supra or infra-renal fixation) has impact on renal function of patients treated by EVAR at our institution.
Material/Methods: Retrospective analysis of the database of AAA treated by EVAR at our institution between December/2001 and December/2013. For each patient we evaluated creatinine/clearance in pre and postoperative periods. Of patients with renal function worsening, we selected those who had acute kidney injury (AKI) according to modified RIFLE criteria, and studied the relationship between AKI and neck thrombus and type of endoprosthesis used. From the database of 241 patients, renal failure patients at the procedure and those in which we didn’t have preoperative and postoperative renal function analyzes were excluded. Regarding the study of the relationship between endoprosthesis used and renal function: 127 were treated with supra-renal fixation endoprostheses, 74 with infra-renal fixation endoprostheses and 27 were excluded (thoracic endoprostheses or missed information). Regarding neck thrombus, we obtained this data for 190 patients.
Results: Regarding the presence of neck thrombus and renal function in postoperative period: of the 190 patients, 21 (11%) developed AKI and neck thrombus in > 25% and> 50% of neck circumference presented statistically significant relationship with the development of AKI (p = 0.045 and p = 0.010, respectively). Regarding the study of endoprostheses used, 14.2% of the patients treated with supra-renal fixation endoprostheses and 5.4% of those treated with infra-renal fixation developed AKI in postoperative period. However, this difference wasn’t statistically significant (p = 0.052).
Discussion/Conclusions: Of our experience, neck thrombus is related to the development of AKI in postoperative period. Patients treated with supra-renal fixation endoprostheses developed more AKI in the postoperative period, but this difference was not statistically significant.
Impact of EVAR's incorporation in the treatment of infrarenal
Abdominal Aortic Aneurysms: achieve the goals of the
European Society of Vascular Surgery. Braz J Cardiovasc Surg.
2. Lederle F, Freischlag J, Kyriakides T, Matsumura J, Padberg F,
Kohler T, et al. Long Term Comparison of Endovascular and. Open
Repair of Abdominal Aortic Aneurysm. New England Journal of
3. Investigators The United Kingdom EVAR Trial. Endovascular
Repair of Aortic Aneurysm in Patients Physically Ineligible
for Open Repair. The New England Journal of Medicine.
4. Chinsakchai K, Hongku K, Hahtapornsawan S, Wongwanit C,
Ruangsetakit C, et al. Outcomes of abdominal aortic aneurysm
with aortic neck thrombus after endovascular abdominal aortic
aneurysm repair. 2014;97(5):518-524
5. Lau LL, Hakaim AG, Oldenburg WA, Neuhauser B, McKinney JM, et al.
Effect of suprarenal versus infrarenal aortic endograft fixation on
renal function and renal artery patency: a comparative study with
intermediate follow-up. J Vasc Surg. 2003 Jun;37(6):1162-1168.
6. Greenberg RK. Abdominal aortic endografting: fixation and
sealing. J Am Coll Surg 2002;194:79-87
7. Johnston K. Multicenter prospective study of nonruptured abdominal
aortic aneurysm. II: Variables in predicting morbidity and
mortality. J Vasc Surg 1989;9:437-447
8. Hertzer NR, Mascha EJ, Karafa MT, O’Hara PJ, Krajewski LP, Beven
EG. Open infrarenal abdominal aortic aneurysm repair: the Cleveland
Clinic experience fro 1989 to 1998. J Vasc Surg 2002;35:1145-1154
9. Miller D, Meyers B. Pathophysiology and prevention of renal failure
associated with thoracoabdominal or abdominal aortic surgery.
J Vasc Surg 1987;5:518-523
10. Greenberg RK, Chuter TAM, Lawrence-Brown M, Haulon S, Nolte
L. Analysis of renal function after aneurysm repair with a device
using suprarenal fixation (Zenith AAA Endovascular Graft) in
contrast to open surgical repair. J Vasc Surg 2004;39:1219-1228
11. Moore WS. The EVT tube and bifurcated endograft systems:
technical considerations and clinical summary. EVI Investigators.
J Endovasc Sug 1997;4:182-194
12. Matsumura J, Brewster D, Makaroun M, Naftel D. A multicentre
controlled clinical trial of open versus endovascular treatment of
abdominal aortic aneurysm. J Vasc Surg 2003;37:262-271
13. Alsac JM, Zarins CK, Heikkinen MA, Karwowski J, Arko FR, Desgrandes
P, et al. The impact of aortic endografts on renal function. J
Vasc Surg 2005;41:926-930
14. Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute
kidney injury: a critical and comprehensive review. Clin Kidney J
(2013) 6: 8–14
15. Miller LE, Razavi MK, Lal BK. Suprarenal versus infrarenal
stent graft fixation on renal complications after endovascular
aneurysm repair. J Vasc Surg. 2015;61(5):1340-1348
16. Gonçalves FB, Verhagen HJM, Chinsakchai K, Keulen JW, Voute
M, et al. The influence of neck thrombus on clinical outcome and
aneurysm morphology after endovascular aneurysm repair. Journal
of vascular surgery; 2012(56):36-44
17. Shintani T, Mitsuoka H, Saitou T, Higashi S. Thromboembolic
complications after endovascular repair of abdominal
aortic aneurysm with neck thrombus. Vas Endovascular Surg
18. Gitlitz DB, Ramaswami G, Kaplan D, Hollier LH, Marin ML. Endovascular
stent grafting in the presence of aortic neck filling defects:
early clinical experience. J Vasc Surg. 2001:33(2):340-4.