The Impact of Suprarenal Fixation on Renal Function Following Endovascular Abdominal Aortic Aneurysm Repair: Meta-analysis Based on Estimated Glomerular Filtration Rate

Background: Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is currently used routinely to treat AAA. Suprarenal fixation (SRF) of EVAR grafts can lead to renal dysfunction. A meta-analysis of studies using estimated glomerular filtration rate (eGFR) as a measure of renal injury to assess the effect of SRF on renal function was performed. Methods: An electronic search was carried out to identify all articles that reported on renal injury following SRF versus infrarenal fixation (IRF) EVAR, and 24 studies were identified. Formal meta-analysis was used to assess eGFR drop at 1 and 5 years. The primary outcome measure was a drop in eGFR > 20% at 1 year; secondary measures included eGFR drop > 20% at 5 years and " renal dysfunction" based on the definition used in each publication. Results: Five series reported eGFR reduction > 20% at 1 year. The weighted odds ratio (OR) was 1.53 (95% CI 0.67-3.51, p = .31, I-2 = 53.2%); 9.3% for SRF versus 7.4% for IRF. One study reported eGFR based renal dysfunction at 5 years: OR 1.77 (95% CI 1.04-3.02, p = .03); 16.9% for SRF versus 10.3% for IRF. Nineteen series reported some form of renal dysfunction (5287 SRF vs. 4386 IRF patients, mean follow up: 20.5 months, range 72 h to 5 years). The weighted OR was 1.32 (95% CI 1.01e1.71, p = .03, I2 = 28.4%); 5.1% for SRF versus 4.6% for IRF. " Renal dysfunction" definitions varied greatly and were based on creatinine or other inaccurate methods. Conclusion: EVAR using SRF does not lead to a significant drop in renal function at 1 year, based on eGFR. Longterm results are limited. Authors should report long-term renal injury using eGFR and not inaccurate arbitrary measures, which are currently common in the literature. (C) 2018 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.