The preservation of accessory renal arteries should be considered the treatment of choice in complex endovascular aortic repair

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dc.contributor.authorTorrealba, Jose, I
dc.contributor.authorKoelbel, Tilo
dc.contributor.authorRohlffs, Fiona
dc.contributor.authorHeidemann, Franziska
dc.contributor.authorSpanos, Kostas
dc.contributor.authorPanuccio, Giuseppe
dc.date.accessioned2025-01-20T21:02:36Z
dc.date.available2025-01-20T21:02:36Z
dc.date.issued2022
dc.description.abstractObjective: The objective of this study was to evaluate renal function and renal parenchymal length changes secondary to the coverage or preservation of accessory renal arteries (ARAs) in complex aortic repair.
dc.description.abstractMethods: This was a single-center retrospective study identifying all patients undergoing fenestrated or branched endovascular aortic repair (f-b EVAR) who presented with ARAs. Two groups were created, a preserved ARA group, with incorporation of the vessel as a dedicated fenestration or branch in the endograft plan, and a non-preserved ARA group, without incorporation of them. Early >30% decline of glomerular filtration rate (GFR), kidney infarcts, and endoleaks were evaluated. Mid-term results with freedom from kidney shrinkage (defined as length decrease >10%) at follow-up, freedom from GFR decrease >30%, or need for postoperative dialysis at follow-up were also analyzed. Primary assisted patency of incorporated ARAs was calculated.
dc.description.abstractResults: From 2011 through 2020, 145 patients undergoing complex aortic repair presented with an ARA. After excluding ruptured aneurysms, 33 patients had the ARA preserved with their incorporation into the stent graft (preserved ARA group), and 99 did not have preservation of them (not-preserved ARA group). There were no statistical differences in demographics or type of aneurysm. Patients in the ARA-preserved group had more ARAs (median of two per patient vs one in the non-preserved ARA group; P=.01) and bigger ARAs (median 4 vs 3 mm in the non-preserved ARA group; P=.001). Early postoperative worsening >30% of GFR (23% vs 6%; P=.03) as well as postoperative renal infarction (57% vs 6%; P=.001) and ARA-related endoleaks (20% vs 0%; P=.01) were statistically higher for the not-preserved ARA group. Midterm kidney length showed significant shrinkage in the not-preserved ARA group compared with the ARA preserved group (9.7% vs 0%; P=.001). Freedom from >30% GFR decline at 2 years was significantly higher for the preserved ARA group (83% vs 47%; P=.01).Two-year primary assisted patency of incorporated ARA was 94%.
dc.description.abstractConclusions: Complex aortic repair incorporation of ARA is feasible, with low complications and good primary assisted patency at 2 years. It leads to less postoperative early renal dysfunction as well as higher freedom for mid-term renal disfunction and kidney shrinkage.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.jvs.2022.02.039
dc.identifier.issn0741-5214
dc.identifier.urihttps://doi.org/10.1016/j.jvs.2022.02.039
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/93059
dc.identifier.wosidWOS:000850835400092
dc.issue.numero3
dc.language.isoen
dc.pagina.final662
dc.pagina.inicio656
dc.revistaJournal of vascular surgery
dc.rightsacceso restringido
dc.subjectAccessory renal artery
dc.subjectAortic aneurysm
dc.subjectEndovascular aneurysm repair
dc.subjectEVAR
dc.subjectKidney injury
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleThe preservation of accessory renal arteries should be considered the treatment of choice in complex endovascular aortic repair
dc.typeartículo
dc.volumen76
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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