The clinical impact of accessory renal arteries coverage after endovascular repair of aneurysms in abdominal and thoraco-abdominal aorta.

Abstract

INTRODUCTION\nThe aim of this systematic review and meta-analysis is to assess the impact of accessory renal artery (ARA) coverage on renal function in terms of acute kidney injury (AKI), renal infarcts, chronic renal failure (CRF), and mortality in patients undergoing standard endovascular aortic aneurysm repair (EVAR) or endovascular repair of complex aneurysms.\n\n\nMETHODS\nAn electronic search of the English language medical literature from 2000 to September 2020 was conducted using MEDLINE, EMBASE, and Cochrane databases with PRISMA methodology for studies reporting on ARA management in patients undergoing endovascular repair of aneurysms in abdominal and thoraco-abdominal aorta. The patients were divided in two groups; group 1: patients with ARA coverage; group 2: without the presence of ARA or without coverage of it in cases of its presence. Each group included two arms, one with patients undergoing standard EVAR and one with endovascular treatment of complex aortic aneurysm. The GRADE approach was used to evaluate the quality of evidence and the summary of findings. The primary outcomes included the incidence of AKI, renal infarcts, CRF and mortality.\n\n\nRESULTS\nTen retrospective non-randomized control studies were included in the systematic review reporting on 1014 patients (302 with covered ARA vs. 712 without ARA or without coverage of it in cases of its presence). In 6 studies, the mean diameter of the covered ARA that was <4mm (ranging from 2.7 to 3.4mm). The mean follow up (FU) was 22.74 months (range: 1-42). In standard EVAR patients the risk of AKI [OR, 0.72; 95% CI, (0.21; 2.51), I2 = 0%] in early period, CRF [OR, 4.44 95% CI, (0.46; 42.61), I2 = 87%] and death [OR, 0.91; 95% CI, (0.36; 2.31), I2 = 0%] during FU was similar between group 1 and 2. Only the risk of renal infracts was higher in patients of group 1 in comparison to group 2 [OR, 93.3; 95% CI, (1.48; 5869), I2 = 92%]. In patients with complex aneurysm repair the risk of AKI [OR, 1.85; 95% CI, (0.61; 5.64), I2 = 42%] in early period, CRF [OR, 1.64; 95% CI, (0.88; 3.07), I2 not applicable] and death [OR, 3.63; 95% CI, (0.14; 96.29), I2 = 56%] during FU was similar between group 1 and 2. Only the risk of renal infracts was higher in patients of group 1 in comparison to group 2 [OR, 8.58; 95% CI, (4.59; 16.04), I2 = 0%].\n\n\nCONCLUSION\nARA (<4mm) coverage in patients undergoing standard EVAR or endovascular repair of complex aneurysms is associated with increased risk of renal infarction. However, there is no clinical impact of ARA coverage on renal function and mortality in early post-operative and follow up period. Preservation of ARA > 4mm should be considered.