PMID- 15192560
OWN - NLM
STAT- MEDLINE
DCOM- 20040811
LR  - 20151119
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 39
IP  - 6
DP  - 2004 Jun
TI  - Analysis of renal function after aneurysm repair with a device using suprarenal 
      fixation (Zenith AAA Endovascular Graft) in contrast to open surgical repair.
PG  - 1219-28
AB  - PURPOSE: This study was undertaken to assess the effect on renal function of open 
      surgery and endovascular abdominal aortic aneurysm (AAA) repair with suprarenal 
      fixation with the Zenith device. METHODS: Data for 279 patients with similar 
      preoperative comorbid conditions were prospectively analyzed after AAA repair. 
      One hundred ninety-nine patients underwent endografting with the Zenith AAA 
      Endovascular Graft, which incorporates suprarenal fixation (Zenith standard risk 
      group, ZSR), and 80 patients underwent open surgery (standard surgical risk 
      group, SSR). Endovascular repair was also performed in 100 patients considered 
      poor candidates for open repair (Zenith high risk group, ZHR). Serum creatinine 
      concentration (SCr) and anatomic defects were assessed before the procedure, 
      before discharge, and at 1, 6, 12, and 24 months in all patients who underwent 
      endovascular repair, and before the procedure and at 1 and 12 months in patients 
      who underwent open surgical repair (only SCr was measured before discharge). 
      Renal function was also analyzed, with a creatinine clearance calculation 
      (Cockcraft-Gault). Renal insufficiency was defined as an increase in SCr greater 
      than 30% from a preoperative baseline value, any SCr concentration in excess of 
      2.0 mg/dL, or any need for dialysis. Cumulative renal infarction and arterial 
      occlusion rates were calculated with computed tomographic, ultrasonographic, and 
      angiographic data, and reported as cumulative values. RESULTS: Despite the 
      initially superior renal function in the ZSR group at the pre-discharge 
      evaluation (P =.01), there were no differences at 12 months with respect to rise 
      in SCr greater than 30% (ZSR, 16%, vs SSR, 12%; P =.67), SCr rise greater than 
      2.0 mg/dL (ZSR, 2.5%, vs SSR, 3.4%; P =.66), incidence of renal artery occlusion 
      (ZSR, 1%, vs SSR, 1.4%; P >.99), or infarction (ZSR, 1.5%, vs SSR, 1.4%; P >.99). 
      Only one patient in each group required hemodialysis. Of note, both groups of 
      patients demonstrated a reduction in creatinine clearance over 12 months, which 
      then stabilized or improved by 24 months for ZSR patients. CONCLUSIONS: Renal 
      dysfunction occurs in a subset of patients regardless of type of repair (open or 
      endovascular with suprarenal fixation). The cause of renal dysfunction after open 
      or endovascular repair with a suprarenal stent is probably multifactorial. The 
      observed dysfunction occurs in a small number of patients, and the effect in the 
      endovascular group (no data for the surgical group at 24 months) appears to be 
      transient. The initial dysfunction, apparent in both groups over 12 months of 
      follow-up, stabilizes or improves at 12 to 24 months.
FAU - Greenberg, Roy K
AU  - Greenberg RK
AD  - Division of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 
      44195, USA. greenbr@ccf.org
FAU - Chuter, Timothy A M
AU  - Chuter TA
FAU - Lawrence-Brown, Michael
AU  - Lawrence-Brown M
FAU - Haulon, Stephan
AU  - Haulon S
FAU - Nolte, Lori
AU  - Nolte L
CN  - Zenith Investigators
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Biomarkers)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
EIN - J Vasc Surg. 2004 Jul;40(1):23
MH  - Aged
MH  - Aortic Aneurysm, Abdominal/*surgery
MH  - Biomarkers/blood
MH  - *Blood Vessel Prosthesis Implantation
MH  - Creatinine/blood
MH  - Equipment Design
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Multivariate Analysis
MH  - Postoperative Complications/*etiology/*physiopathology/surgery
MH  - Prospective Studies
MH  - Renal Artery Obstruction/etiology/physiopathology/surgery
MH  - Renal Insufficiency/*etiology/*physiopathology/surgery
MH  - Reoperation
MH  - Stents
MH  - Time Factors
MH  - *Tissue Fixation
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2004/06/12 05:00
MHDA- 2004/08/12 05:00
CRDT- 2004/06/12 05:00
PHST- 2004/06/12 05:00 [pubmed]
PHST- 2004/08/12 05:00 [medline]
PHST- 2004/06/12 05:00 [entrez]
AID - S0741521404002915 [pii]
AID - 10.1016/j.jvs.2004.02.033 [doi]
PST - ppublish
SO  - J Vasc Surg. 2004 Jun;39(6):1219-28. doi: 10.1016/j.jvs.2004.02.033.