Altered renal functions in patients with occlusion of an accessory renal artery after endovascular stenting of an infrarenal aneurysm
Altered renal functions in patients with occlusion of an accessory renal artery after endovascular stenting of an infrarenal aneurysm
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肾下动脉瘤血管内支架置入术后副肾动脉闭塞患者的肾功能改变
DOI：
10.1016/j.jvs.2016.06.116
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发表时间：
2017
影响因子：
4.3
通讯作者：
J. Heyn
中科院分区：
文献类型：
--
作者：
M. Sadeghi‐Azandaryani;H. Zimmermann;I. Korten;Alexander Klose;P. Scheiermann;M. Treitl;J. Heyn
腹主动脉瘤腔内修复术（EVAR）期间覆盖副肾动脉（ARA）可能导致肾梗死（RI）或肾功能下降。到目前为止，仍不清楚哪些患者有发生这些并发症的风险。因此，我们分析了ARA密封腹主动脉瘤腔内修复术的RI和肾功能的发生方面的效果。MethodsA回顾性分析的病历和计算机断层扫描的患者进行腹主动脉瘤腔内修复术在一个为期5年。腹主动脉瘤腔内修复术前特别注意是否存在副肾动脉和肾功能。34例ARA患者与102例无ARA患者按1：3配对。分析了有和无ARA患者的腹主动脉瘤腔内修复术后结果。在ARA患者中，我们进一步检查了EVAR前估计肾小球滤过率（eGFR）≥ 60 mL/min和eGFR < 60 mL/min的患者EVAR后的结果。结果EVAR前，ARA患者的中位eGFR为74 mL/min（第25/75次随访，57/89），无ARA患者为72 mL/min（第25/75次随访，63/87）。腹主动脉瘤腔内修复术后1周（ARA，−10.7 ± 16.9 mL/min vs无ARA，1.2 ± 13.3 mL/min;P= 0.002）和6个月后（ARA，−10.8 ± 17.4 mL/min vs无ARA，1.2 ± 13.3 mL/min;P= 0.001），ARA患者的eGFR变化显著高于无ARA患者。RI仅发生于ARA患者。在ARA患者组中，与腹主动脉瘤腔内修复术后1周肾功能受损（IF）患者相比，肾功能正常（NF）患者术前eGFR下降更明显（NF，−14.3 ± 18.0 mL/min vs IF，−1.3 ± 10.8 mL/min;P= .02）和6个月后（NF，−15.8 ± 17.9 mL/min vs IF，0.1 ± 15.2 mL/min;P= 0.007）。结论腹主动脉瘤腔内修复术后ARA患者的肾功能下降比腹主动脉瘤腔内修复术后无ARA患者更明显。在ARA患者中，观察到的肾功能下降在术前存在NF的患者中显著不同。因此，腹主动脉瘤腔内修复术后IF的风险似乎在ARA和术前肾功能正常的患者中增加。
ObjectiveCoverage of an accessory renal artery (ARA) during endovascular aneurysm repair (EVAR) may result in renal infarction (RI) or decline in renal function. Until now, it remains vague which patients are at risk to develop these complications. We therefore analyzed the effect of ARA sealing by EVAR with respect to the occurrence of RI and renal function.MethodsA retrospective analysis of the medical records and computed tomographic scans of patients who underwent EVAR within a period of 5 years was performed. Particular attention was paid to the presence or absence of accessory renal arteries and renal function before EVAR. Thirty-four patients with ARA were matched 1:3 to 102 patients without ARA. The results after EVAR were analyzed in patients with and without ARA. In patients with ARA, we further examined the results after EVAR in patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min and eGFR < 60 mL/min before EVAR.ResultsBefore EVAR, the median eGFR was 74 mL/min (25th/75th percentiles, 57/89) in patients with ARA and 72 mL/min (25th/75th percentiles, 63/87) in patients without ARA. Alterations in eGFR were significantly pronounced in patients with ARA when compared with patients without ARA 1 week after EVAR (ARA, −10.7 ± 16.9 mL/min vs without ARA, 1.2 ± 13.3 mL/min;P= .002) and after 6 months (ARA, −10.8 ± 17.4 mL/min vs without ARA, 1.2 ± 13.3 mL/min;P= .001). RI only occurred in patients with ARA. Within the group of patients with ARA, patients with normal renal function (NF) showed a more pronounced decline in eGFR preoperatively when compared with patients with impaired renal function (IF) 1 week after EVAR (NF, −14.3 ± 18.0 mL/min vs IF, −1.3 ± 10.8 mL/min;P= .02) and after 6 months (NF, −15.8 ± 17.9 mL/min vs IF, 0.1 ± 15.2 mL/min;P= .007).ConclusionsThe decrease in renal function was more pronounced in patients with ARA after EVAR when compared with patients without ARA undergoing EVAR. In patients with ARA, the observed decline in renal function was significantly distinct in patients presenting NF preoperatively. Consequently, the risk of IF after EVAR seems to be increased in patients with ARA and normal preoperative renal function.