P-069 - A SYSTEMATIC REVIEW OF RENAL FUNCTION CHANGES AFTER ENDOVASCULAR REPAIR OF THORACOABDOMINAL ANEURYSMS BY FENESTRATED AND BRANCHED ENDOGRAFTING.

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Gallitto E. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Faggioli G. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Campana F. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Pini R. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Spath P. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Ancetti S. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Logiacco A. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy) , Gargiulo M. ( Vascular Surgery, University of Bologna ~ Bologna ~ Italy)
Introduction:
Fenestrated and branched endografting (F/B-EVAR) is an established technique to treat thoracoabdominal aortic aneurysms (TAAAs) in anatomically selected and high surgical-risk patients, with reliable early and mid-term results. Renal function worsening is one of the most frequent postoperative adverse events with significant negative effects on early and late survival. However, data in the literature are inconsistent and a methodical overview is currently lacking. Aim of the present study was to analyze the available figures on postoperative renal function after F/B-EVAR in TAAAs repair
Methods:
A systematic literature review was registered on the PROSPERO register (registration code: CRD42021290354) and performed according to the PRISMA guidelines. An English-language literature search was performed through PubMed, Scopus and Cochrane library to identify any study reporting the outcome of F/B-EVAR repair of TAAAs published between 2010 and 2021. The keywords used included 'thoracoabdominal aneurysm' [All Fields] AND 'renal function' [All Fields] AND 'endograft' [All Fields] AND ('branched' [All Fields] OR 'fenestrated' [All Fields]). Only studies reporting data on the postoperative renal function were included in the analysis. The different definitions of renal function worsening, its incidence within 30 postoperative days and the need for dialysis were assessed as main outcomes. Secondary outcomes were renal function worsening during follow-up, risk factors associated with early/follow-up renal function worsening and its impact on early and late survival.
Results:
Figure 1 shows the paradigm of studies selection. Among 490 screened records, 23 studies were considered eligible for the present review, for an overall of 1944 patients (male:72%; mean age: 70±3 years) treated between 2004 and 2020. Crawford's extent I-III and IV were 1253 (71%) and 519 (29%), respectively; the Crawford's extent was not described in 169 patients. One hundred ninety-one (6%) cases were post-dissection TAAAs. Chronic preoperative renal function impairment was present in 565 (33%) cases. Custom made endografts were implanted in 926 (77%) cases; 199 (24%) patients were managed in urgent setting with off the shelf devices. Nine different definitions of renal function worsening were reported as summarized in Figure 2. The most frequent definitions adopted were estimated glomerular filtration rate (eGFR) reduction > 30% of baseline level (9 papers, 39%), RIFLE (4 papers - 18%) and KDIGO's classifications (4 papers - 18%). The incidence of renal function worsening within 30 postoperative days was 14% (3-36%), with a new-onset of dialysis of 5% (1-26%), being permanent in 4% (0-8%) of cases. Four studies reported data about the renal function worsening during follow-up, with a mean rate of 9% (2-17%). The need for dialysis during follow-up was reported in 7 studies with a mean rate of 2% (2-9%), leading to an overall rate of postoperative dialysis of 5% (2-18%). Only 3 studies reported risk factors for early postoperative renal function worsening. Single stage TAAAs repair (P:.038) and early surgeon's experience (OR: 7.74; 95% CI: 1.3 - 43.9; P:.019) were identified as independent predictors of renal function worsening. Preoperative left ventricular ejection fraction < 40% (OR: 40.6; 95% CI: 2.47 - 668; P:.009) and procedure duration (OR: 1.1; 95% CI: 1.002-1.028; P:.019) were associated to postoperative dialysis. No study identified risk factors for postoperative renal function worsening during follow-up. Finally, one paper reported that postoperative renal function worsening was associated with a reduced long-term survival (P:0.4).
Conclusion:
Renal function worsening within 30 postoperative days is not negligible after F/B-EVAR for TAAAs and occurs in 14% of cases with 4% of permanent dialysis. However, the definition of renal function worsening is currently heterogeneous and international reporting standard should be uniformly adopted in order to perform a significant analysis. The problem of renal function worsening after TAAA endovascular repair, together with ell its predictors and the consequences on patients' survival is still inadequately evaluated and should be further investigated
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