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Home > Vascular Annual Meeting > SS37. Open Surgical Repair of Pararenal...

SS37. Open Surgical Repair of Pararenal Abdominal Aortic Aneurysms: Long-Term Outcomes of Renal Function

Joseph J. Ricotta, II, Audra A. Duncan, Catalin Harbuzariu, Thomas C. Bower, Gustavo S. Oderich, Manju Kalra, Christine Lohse, Peter Gloviczki
Mayo Clinic, Rochester, MN

OBJECTIVES: Pararenal abdominal aortic aneurysms (PAAAs) are increasingly being repaired with endovascular techniques. In order to assess long-term outcomes, particularly renal function, future endovascular repairs must be compared to an open repair gold standard presented in this report.

METHODS: Between 1993 and 2003, 3,058 abdominal aortic aneurysms were repaired including 257 PAAAs, of which 252 had long-term follow-up, and 229 had long-term glomerular filtration rate (GFR) assessment. Patients with an estimated GFR<60 mL/min/1.73m2 were considered to have renal dysfunction at the time of surgery. Patients with a >30% decrease in GFR were considered to have a significant decline in renal function following surgery. Overall survival and survival free of a significant decline in renal function were estimated using the Kaplan-Meier method.

RESULTS: There were 205 men (81%) and 47 women (19%); 130 (52%) had preoperative renal dysfunction with 19 (8%) on dialysis before surgery. Of the 252 patients, 131 died at a median of 4.2 years following surgery (range 0 days to 14.0 years). Median duration of follow-up was 3.3 years (range 3 days to 14.1 years). Estimated overall survival rates at 1, 3, 5, 7, and 10 years following surgery were 92%, 76%, 61%, 43%, and 23%, respectively. There was no difference in survival between patients with and without preoperative renal dysfunction (p=0.3). Significant decline in renal function occurred in 32 of 229 (14%) at a median of 2.9 years post-operatively. Estimated survival free of a significant decline in renal function rates at 1, 3, 5, 7, and 10 years following surgery were 93%, 89%, 83%, 75%, and 54%, respectively. Decline in renal function was associated with (p<0.01) increased mesenteric ischemia time, supravisceral clamping and renal artery bypass, but not preoperative renal dysfunction (p=0.6) or dialysis requirement (p=0.3).

CONCLUSIONS: Long-term decline in renal function may affect up to 14% of patients undergoing open PAAA repair, but does not affect long-term survival. Patients at risk for post-operative renal dysfunction such as those with PAAA requiring supravisceral clamping or renal artery bypass may be better managed with endovascular repair depending on the future long-term results of branched or fenestrated endografts.

AUTHOR DISCLOSURES: J.J. Ricotta, None; A.A. Duncan, None; C. Harbuzariu, None; T.C. Bower, None; G.S. Oderich, None; M. Kalra, None; C. Lohse, None; P. Gloviczki, None.