Zdenek Novak, Marc A. Passman, Thomas C. Matthews, Mark A. Patterson, William D. Jordan
Vascular Surgery, University of Alabama at Birmingham, Birmingham, AL.
OBJECTIVES: To compare renal function outcomes of open repair, endovascular therapy and surveillance for renal artery aneurysm (RAA).
METHODS: Medical records of 40 patients with RAA encountered between 2000-2012 were reviewed and divided into 3 groups: endovascular therapy (ET, n=9), open repair (OR, n=20) and surveillance (SV, n=11). Creatinine level GFR estimates were based on MDRD equation. Nuclear studies were used to assess renal flow/lateralization. Hypertension (HTN) severity was assessed based upon the number of medications used. SPSS package (IBM) was used for statistical analysis.
RESULTS: Demographics of all groups were similar. The average size (mm) of RAA at the time of treatment was 19±6 for ET and 22±7.4 for OR. The average HTN meds number before and after treatment for ET was 2.3±1.5 → 3±1.8 and for OR: 1.7±1.1 → 1.7±0.9. HTN control after intervention worsened in 33% of ET and 15% of OR patients and improved in 11.1% of ET and 20% of OR patients. The renal flow was more frequently lateralized (affected side flow <45%) in the ET after the procedure (20% (4/5) vs. 50% (4/8) in OR). The average GFR (ml/min/1.73m2) changed from 71.3 to 55.2 for ET and from 82 to 81.4 for OR. No patient progressed to dialysis during 1-10 years of surveillance. We also observed significant (p<0.01) difference in hospital stay (ET: 2.37±2.32 vs. OR: 8.94±4.96 days). In the SV group, the average RAA size at presentation was 18±6.6mm with no significant growth over 2-66 months of surveillance. The average GFR was 75 at presentation and 79.7 at the latest visit. HTN control was similar with 2.4±1.9 meds at the beginning and 2.1±1.2 meds at the latest visit. None of the SV patients crossed over to treatment groups. RAA rupture was not observed.
CONCLUSIONS: Open repair of RAA tends to provides better preservation of renal function than endovascular treatment. While endovascular repair has less early morbidity and shorter hospital stays, the reduced renal preservation may have a negative impact on HTN control.
AUTHOR DISCLOSURES: W. D. Jordan: WL Gore; Medtronic; Abbott, Consulting fees or other remuneration (payment) Aptus; Volcano, Consulting fees or other remuneration (payment)WL Gore, Research grants; Medtronic, Research grants; Abbott, Research grants; Aptus, Research grants; Volcano, Research grants; Maquet, Research grants; Terumo, Research grants; Endologix, Research grants; Trivascular, Research grants; Cook Medical, Research grants; ev3, Research grants; LeMaitre, Research grants; Lombard, Research grants; T. C. Matthews: Nothing to disclose; Z. Novak: Nothing to disclose; M. A. Passman: Nothing to disclose; M. A. Patterson: Nothing to disclose.
Posted April 2013