Impact of Accessory Renal Artery Embolization on Renal Deterioration Under Endovascular Aortic Repair

Abstract

Objective

The optimal management strategy for patients with accessory renal arteries undergoing endovascular aortic repair is unclear. This study aimed to investigate the impact of accessory renal artery (aRA) embolization on postoperative renal deterioration and to identify the predictors of postoperative renal deterioration in patients who underwent endovascular aortic repair (EVAR).

Methods

A retrospective single-centre observational study was conducted at our hospital. Of 331 consecutive patients who underwent endovascular aortic repair between April 2011 and February 2021, 29 patients with an aRA were included in this study. Spearman’s rank correlation coefficients of decrease in estimated glomerular filtration rate (eGFR), renal volume reduction rate, infarcted renal volume, and quantity of contrast use for postoperative renal deterioration were analyzed. The correlation coefficients of the correlations between infarcted renal volume, renal volume reduction rate, and decrease in eGFR and the rate of aRA diameter were also analyzed. Multivariable nominal logistic regression analyses were conducted to evaluate the odds of postoperative renal deterioration.

Results

The renal volume reduction rate and infarcted renal volume had a significant positive correlation with the decrease in eGFR. Body surface area and preoperative renal volume were significantly but negatively correlated with the decrease in eGFR. The infarcted renal volume, renal volume reduction rate, and decrease in eGFR were significantly and positively correlated with the aRA diameter. The odds ratio for decreased eGFR rate in preoperative renal volume was .96 (95% CI 0.930‒.996, P = .009).

Conclusions

EVAR with aRA embolization impacts postoperative renal deterioration in patients with preoperative low renal volume, and the diameter of the embolized aRA might be a predictor of postoperative renal deterioration.

Keywords

endovascular aneurysm repair embolization accessory renal artery renal function endoleak

Get full access to this article

View all access options for this article.

References

Khan

Salata

, et al. A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg. 2019;70:954-969.

Ozkan

Oğuzkurt

Tercan

Kizilkiliç

Koç

Koca

. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol. 2006;12:183-186.

Urban

Ratner

Fishman

. Three-dimensional volume-rendered CT angiography of the renal arteries and veins: normal anatomy, variants, and clinical applications. Radiographics. 2001;21:373-386. questionnaire 549–55.

Malgor

Oderich

Vrtiska

, et al. A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair. J Vasc Surg. 2013;58:1467-1475.

Loffroy

Midulla

. Type II endoleak involving an accessory renal artery and the inferior mesenteric artery. Eur J Vasc Endovasc Surg. 2020;60:460.

Franz

Nguyen

. A unique case of a type II endoleak after EVAR caused by patent inferior mesenteric and accessory renal arteries. Vasc Endovascular Surg. 2011;45:651-653.

Jackson

Fay

Wyatt

Rose

. The renal impact of aortic stent-grafting in patients with a horseshoe kidney. Cardiovasc Intervent Radiol. 2004;27:632-636.

Maurer

Verloh

Lürken

, et al. Kidney failure after occlusion of accessory renal arteries in endovascular abdominal aneurysm repair. Cardiovasc Intervent Radiol. 2019;42:1687-1694.

Greenberg

Dorsey

Dalman

, et al. Long-term results after accessory renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg. 2012;56:291-296. discussion 296–7.

10.

Edwards

Wooster

Tanious

Back

. Management of aortoiliac aneurysms with atypical renal artery anatomy. Ann Vasc Surg. 2019;54:110-117.

11.

Isotani

Shimoyama

Yokota

, et al. Novel prediction model of renal function after nephrectomy from automated renal volumetry with preoperative multidetector computed tomography (MDCT). Clin Exp Nephrol. 2015;19:974-981.

12.

Eisendrath

Phifer

Culver

. Bladder Neck Obstructions. How can the operative Mortality be lowered and the End results Improved. Ann Surg. 1925;15:1037-1041.

13.

Lareyre

Raffort

Carboni

, et al. Impact of polar renal artery coverage after fenestrated endovascular aortic repair for juxtarenal and type IV thoracoabdominal aortic aneurysms. Ann Vasc Surg. 2019;58:45-53.

14.

Karmacharya

Parmer

Antezana

, et al. Outcomes of accessory renal artery occlusion during endovascular aneurysm repair. J Vasc Surg. 2006;43:8-13.

15.

Dzieciuchowicz

Espinosa

Diaz

Lavilla Roya

Lostao

. Renal function in patients treated with abdominal aortic stentgraft implantation with an intentional occlusion of accessory renal artery. Ann Vasc Surg. 2012;26:299-305.

16.

Tenorio

Kärkkäinen

Marcondes

, et al. Impact of intentional accessory renal artery coverage on renal outcomes after fenestrated-branched endovascular aortic repair. J Vasc Surg. 2021;73:805-818. e2.

17.

Abu Bakr

Torsello

Pitoulias

Stavroulakis

Austermann

Donas

. Preservation of clinically relevant accessory renal arteries in infrarenal AAA patients with adequate proximal landing zones undergoing evar. J Endovasc Ther. 2016;23:314-320.

18.

Graves

Jackson

. The current state of fenestrated and branched devices for abdominal aortic aneurysm repair. Semin Intervent Radiol. 2015;32:304-310.

19.

Boyacıoğlu

Ketenciler

. Endovascular stent graft repair with chimney technique of an abdominal aortic aneurysm with concomitant horseshoe kidney. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;28:377-381.