Editor's Choice – Comparison of Renal Outcomes in Patients Treated by Zenith® Fenestrated and Zenith® Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials

Zenith Fenestrated and the Zenith Infrarenal Stent grafts Trial Investigators, L. R. de Souza, G. S. Oderich, M. A. Farber, S. Haulon, P. V. Banga, A. H. Pereira, P. Gloviczki, S. C. Textor, F. Jia

Research output: Contribution to journalArticle

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Abstract

Objective/Background Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. Methods Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years. Results AKI at 1 month was similar between groups, with > 25% decline in eGFR observed in 5% of FEVAR and 9% of EVAR patients (p = .39). There were no significant differences in > 25% decline in eGFR at 2 years (FEVAR 20% vs. EVAR 20%; p > .99) or 5 years (FEVAR 27% vs. EVAR 50%; p = .50). Progression to stage IV–V CKD was similar at 2 years (FEVAR 2% vs. EVAR 3%; p > .99) and 5 years (FEVAR 7% vs. EVAR 8%; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22%] vs. 3/134 [2%]; p < .001) and renal related re-interventions (12/67 [18%] vs. 4/134 [3%]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5% vs. 1.5%; p > .99). Conclusion Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.

LanguageEnglish (US)
Pages648-655
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume53
Issue number5
DOIs
StatePublished - May 1 2017

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Abdominal Aortic Aneurysm
Stents
Glomerular Filtration Rate
Transplants
Kidney
Chronic Renal Insufficiency
Acute Kidney Injury
Creatinine
Propensity Score
Renal Artery Obstruction
Serum
Renal Insufficiency
Dialysis
Hypertension

Keywords

  • Acute kidney injury
  • Aortic aneurysm
  • Chronic kidney disease
  • FEVAR

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Editor's Choice – Comparison of Renal Outcomes in Patients Treated by Zenith® Fenestrated and Zenith® Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials. / Zenith Fenestrated and the Zenith Infrarenal Stent grafts Trial Investigators.

In: European Journal of Vascular and Endovascular Surgery, Vol. 53, No. 5, 01.05.2017, p. 648-655.

Research output: Contribution to journalArticle

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title = "Editor's Choice – Comparison of Renal Outcomes in Patients Treated by Zenith{\circledR} Fenestrated and Zenith{\circledR} Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials",
abstract = "Objective/Background Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. Methods Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years. Results AKI at 1 month was similar between groups, with > 25{\%} decline in eGFR observed in 5{\%} of FEVAR and 9{\%} of EVAR patients (p = .39). There were no significant differences in > 25{\%} decline in eGFR at 2 years (FEVAR 20{\%} vs. EVAR 20{\%}; p > .99) or 5 years (FEVAR 27{\%} vs. EVAR 50{\%}; p = .50). Progression to stage IV–V CKD was similar at 2 years (FEVAR 2{\%} vs. EVAR 3{\%}; p > .99) and 5 years (FEVAR 7{\%} vs. EVAR 8{\%}; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22{\%}] vs. 3/134 [2{\%}]; p < .001) and renal related re-interventions (12/67 [18{\%}] vs. 4/134 [3{\%}]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5{\%} vs. 1.5{\%}; p > .99). Conclusion Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.",
keywords = "Acute kidney injury, Aortic aneurysm, Chronic kidney disease, FEVAR",
author = "{Zenith Fenestrated and the Zenith Infrarenal Stent grafts Trial Investigators} and {de Souza}, {L. R.} and Oderich, {G. S.} and Farber, {M. A.} and S. Haulon and Banga, {P. V.} and Pereira, {A. H.} and P. Gloviczki and Textor, {S. C.} and F. Jia",
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AU - Zenith Fenestrated and the Zenith Infrarenal Stent grafts Trial Investigators

AU - de Souza,L. R.

AU - Oderich,G. S.

AU - Farber,M. A.

AU - Haulon,S.

AU - Banga,P. V.

AU - Pereira,A. H.

AU - Gloviczki,P.

AU - Textor,S. C.

AU - Jia,F.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objective/Background Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. Methods Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years. Results AKI at 1 month was similar between groups, with > 25% decline in eGFR observed in 5% of FEVAR and 9% of EVAR patients (p = .39). There were no significant differences in > 25% decline in eGFR at 2 years (FEVAR 20% vs. EVAR 20%; p > .99) or 5 years (FEVAR 27% vs. EVAR 50%; p = .50). Progression to stage IV–V CKD was similar at 2 years (FEVAR 2% vs. EVAR 3%; p > .99) and 5 years (FEVAR 7% vs. EVAR 8%; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22%] vs. 3/134 [2%]; p < .001) and renal related re-interventions (12/67 [18%] vs. 4/134 [3%]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5% vs. 1.5%; p > .99). Conclusion Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.

AB - Objective/Background Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. Methods Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years. Results AKI at 1 month was similar between groups, with > 25% decline in eGFR observed in 5% of FEVAR and 9% of EVAR patients (p = .39). There were no significant differences in > 25% decline in eGFR at 2 years (FEVAR 20% vs. EVAR 20%; p > .99) or 5 years (FEVAR 27% vs. EVAR 50%; p = .50). Progression to stage IV–V CKD was similar at 2 years (FEVAR 2% vs. EVAR 3%; p > .99) and 5 years (FEVAR 7% vs. EVAR 8%; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22%] vs. 3/134 [2%]; p < .001) and renal related re-interventions (12/67 [18%] vs. 4/134 [3%]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5% vs. 1.5%; p > .99). Conclusion Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.

KW - Acute kidney injury

KW - Aortic aneurysm

KW - Chronic kidney disease

KW - FEVAR

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