Title:Renal Function Impairment in Patients Undergoing Elective EVAR vs. Elective Open Repair During Follow up Period: A Systematic Review of the Literature
VOLUME: 15 ISSUE: 2
Author(s):Konstantinos Spanos, Christos Karathanos, Athanasios Athanasoulas, Vasileios Saleptsis, Ioannis Vasilopoulos, Sokol Xhepa, Miltiadis Matsagkas and Athanasios D. Giannoukas
Affiliation:Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa
Keywords:Endovascular abdominal aortic aneurysm repair, open surgical aortic aneurysm repair, renal impairment, renal
function.
Abstract:Background: Endovascular (EVAR) or open surgical (OSR) repair are current treatment options
for abdominal aortic aneurysm (AAA).
Objective: To produce a systematic review comparing the impact of these 2 treatment options on renal
function during mid- and long term follow up.
Methods: The MEDLINE, EMBASE and Cochrane databases and key references were searched.
Results: Six studies were included from 2000 to 2016, (4 retrospective and 2 RCT studies) reporting on
2,102 patients (54%; 1096 EVAR, 46%; 1006 OSR). The mean age in EVAR group ranged from 69.4 to
73.8 years (91% males), and in OSR group from 68 to 73.6 years (91% males). The data were too heterogeneous
to perform a meta-analysis. All studies used GFR (Glomerular Filtration Rate) or estimated
GFR (eGFR) to record renal function. The commonest risk factors were the presence of hypertension
(77.5%), hyperlipidaemia (48.3%), coronary artery disease (42%) and smoking (37.8%). During follow
up, new events of renal impairment (increase >20% in GFR) in EVAR patients and in OSR patients
were 58 (5.3%) and 52 (5.2%), respectively. The mean GFR was decreased during follow up period in
both types of the procedure.
Conclusion: There is lack of definitive evidence to prove the superiority of OSR over EVAR regarding
renal function in the post-operative follow up period. It appears that renal impairment may occur after
both interventions. Further prospective research is needed to clarify the issue.
