T Calderbank1, M Bown1, A Saratzis2. 1. NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK. 2. NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK. Electronic address: as875@le.ac.uk.
Abstract
BACKGROUND: Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is currently used routinely to treat AAA. Suprarenal fixation (SRF) of EVAR grafts can lead to renal dysfunction. A meta-analysis of studies using estimated glomerular filtration rate (eGFR) as a measure of renal injury to assess the effect of SRF on renal function was performed. METHODS: An electronic search was carried out to identify all articles that reported on renal injury following SRF versus infrarenal fixation (IRF) EVAR, and 24 studies were identified. Formal meta-analysis was used to assess eGFR drop at 1 and 5 years. The primary outcome measure was a drop in eGFR >20% at 1 year; secondary measures included eGFR drop >20% at 5 years and "renal dysfunction" based on the definition used in each publication. RESULTS: Five series reported eGFR reduction >20% at 1 year. The weighted odds ratio (OR) was 1.53 (95% CI 0.67-3.51, p = .31, I2 = 53.2%); 9.3% for SRF versus 7.4% for IRF. One study reported eGFR based renal dysfunction at 5 years: OR 1.77 (95% CI 1.04-3.02, p = .03); 16.9% for SRF versus 10.3% for IRF. Nineteen series reported some form of renal dysfunction (5287 SRF vs. 4386 IRF patients, mean follow up: 20.5 months, range 72 h to 5 years). The weighted OR was 1.32 (95% CI 1.01-1.71, p = .03, I2 = 28.4%); 5.1% for SRF versus 4.6% for IRF. "Renal dysfunction" definitions varied greatly and were based on creatinine or other inaccurate methods. CONCLUSION: EVAR using SRF does not lead to a significant drop in renal function at 1 year, based on eGFR. Long-term results are limited. Authors should report long-term renal injury using eGFR and not inaccurate arbitrary measures, which are currently common in the literature.
BACKGROUND: Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is currently used routinely to treat AAA. Suprarenal fixation (SRF) of EVAR grafts can lead to renal dysfunction. A meta-analysis of studies using estimated glomerular filtration rate (eGFR) as a measure of renal injury to assess the effect of SRF on renal function was performed. METHODS: An electronic search was carried out to identify all articles that reported on renal injury following SRF versus infrarenal fixation (IRF) EVAR, and 24 studies were identified. Formal meta-analysis was used to assess eGFR drop at 1 and 5 years. The primary outcome measure was a drop in eGFR >20% at 1 year; secondary measures included eGFR drop >20% at 5 years and "renal dysfunction" based on the definition used in each publication. RESULTS: Five series reported eGFR reduction >20% at 1 year. The weighted odds ratio (OR) was 1.53 (95% CI 0.67-3.51, p = .31, I2 = 53.2%); 9.3% for SRF versus 7.4% for IRF. One study reported eGFR based renal dysfunction at 5 years: OR 1.77 (95% CI 1.04-3.02, p = .03); 16.9% for SRF versus 10.3% for IRF. Nineteen series reported some form of renal dysfunction (5287 SRF vs. 4386 IRF patients, mean follow up: 20.5 months, range 72 h to 5 years). The weighted OR was 1.32 (95% CI 1.01-1.71, p = .03, I2 = 28.4%); 5.1% for SRF versus 4.6% for IRF. "Renal dysfunction" definitions varied greatly and were based on creatinine or other inaccurate methods. CONCLUSION: EVAR using SRF does not lead to a significant drop in renal function at 1 year, based on eGFR. Long-term results are limited. Authors should report long-term renal injury using eGFR and not inaccurate arbitrary measures, which are currently common in the literature.
Authors: Alexander Geragotellis; Kofi Cox; Ho Cheung Anthony Yip; Matti Jubouri; Ian M Williams; Damian M Bailey; Mohamad Bashir Journal: Cardiovasc Diagn Ther Date: 2022-08
Authors: Pantelis Sarafidis; Sven Martens; Athanasios Saratzis; Daniella Kadian-Dodov; Patrick T Murray; Catherine M Shanahan; Allen D Hamdan; Daniel T Engelman; Ulf Teichgräber; Charles A Herzog; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Holger Reinecke; Kirsten Johansen Journal: Cardiovasc Res Date: 2022-09-20 Impact factor: 13.081