Endovascular vs open repair of renal artery aneurysms: outcomes of repair and long-term renal function
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Endovascular vs open repair of renal artery aneurysms: outcomes of repair and long-term renal function. / Tsilimparis, Nikolaos; Reeves, James G; Dayama, Anand; Perez, Sebastian D; Debus, E Sebastian; Ricotta, Joseph J.
In: J AM COLL SURGEONS, Vol. 217, No. 2, 08.2013, p. 263-269.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Endovascular vs open repair of renal artery aneurysms: outcomes of repair and long-term renal function
AU - Tsilimparis, Nikolaos
AU - Reeves, James G
AU - Dayama, Anand
AU - Perez, Sebastian D
AU - Debus, E Sebastian
AU - Ricotta, Joseph J
N1 - Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2013/8
Y1 - 2013/8
N2 - BACKGROUND: Endovascular treatment (ER) of renal artery aneurysms (RAA) has been widely used recently due to its assumed lower morbidity and mortality compared with open surgery (OS). The purpose of this study was to investigate the outcomes of OS and ER, and compare long-term renal function.STUDY DESIGN: Data from 2000 to 2012 were retrospectively collected to identify patients who were treated for RAA in a single institution. Morbidity, mortality, freedom from reinterventions, and renal function were compared between OS and ER for RAA.RESULTS: Forty-four RAA repairs were identified in 40 patients (28 women, mean age ± SD 54 ± 13 years). Twenty RAA were repaired with OS (45%) and 24 RAA (55%) with ER. Mean aneurysm sizes were 2.5 ± 1.5 cm (OS) and 2.2 ± 2.2 cm (ER; p = 0.66). Endovascular repair included coil embolization with or without stent placement in 19 patients (79%) and stent grafts in 4 (17%). Open surgery included excision or aneurysmorrhaphy of the aneurysm in 11 kidneys (55%), graft interposition or bypass in 4 (20%), and 4 nephrectomies (20%). There was 1 technical failure in each group. Comorbidities were similar between the 2 groups (American Society of Anesthesiologists III-IV: OS, 40%; ER, 58%; p = 0.44). Endovascular repair and OR had equivalent perioperative morbidity (any complication OS, 15%, ER, 17%, p = 1.0) and no mortality (OS, 0%, ER, 0%). Endovascular repair was associated with shorter hospitalization (OS, 6.3 ± 2.5; ER, 2 ± 3.4 days, p < 0.001). Mean follow-ups were 21 ± 32 months (OS) and 27 ± 36 months (ER). A 30% reduction in glomerular filtration rate occurred in 12.5% of OS patients and 9.1% of ER patients (p = 1.00). Freedom from reintervention at 12 and 24 months were OS, 82%/82% and ER, 82%/74%, respectively (log-rank-test = 0.23).CONCLUSIONS: Endovascular repair of RAA is as safe and effective as open repair in selected patients with appropriate anatomy. There was no difference in decline in renal function between OS and ER.
AB - BACKGROUND: Endovascular treatment (ER) of renal artery aneurysms (RAA) has been widely used recently due to its assumed lower morbidity and mortality compared with open surgery (OS). The purpose of this study was to investigate the outcomes of OS and ER, and compare long-term renal function.STUDY DESIGN: Data from 2000 to 2012 were retrospectively collected to identify patients who were treated for RAA in a single institution. Morbidity, mortality, freedom from reinterventions, and renal function were compared between OS and ER for RAA.RESULTS: Forty-four RAA repairs were identified in 40 patients (28 women, mean age ± SD 54 ± 13 years). Twenty RAA were repaired with OS (45%) and 24 RAA (55%) with ER. Mean aneurysm sizes were 2.5 ± 1.5 cm (OS) and 2.2 ± 2.2 cm (ER; p = 0.66). Endovascular repair included coil embolization with or without stent placement in 19 patients (79%) and stent grafts in 4 (17%). Open surgery included excision or aneurysmorrhaphy of the aneurysm in 11 kidneys (55%), graft interposition or bypass in 4 (20%), and 4 nephrectomies (20%). There was 1 technical failure in each group. Comorbidities were similar between the 2 groups (American Society of Anesthesiologists III-IV: OS, 40%; ER, 58%; p = 0.44). Endovascular repair and OR had equivalent perioperative morbidity (any complication OS, 15%, ER, 17%, p = 1.0) and no mortality (OS, 0%, ER, 0%). Endovascular repair was associated with shorter hospitalization (OS, 6.3 ± 2.5; ER, 2 ± 3.4 days, p < 0.001). Mean follow-ups were 21 ± 32 months (OS) and 27 ± 36 months (ER). A 30% reduction in glomerular filtration rate occurred in 12.5% of OS patients and 9.1% of ER patients (p = 1.00). Freedom from reintervention at 12 and 24 months were OS, 82%/82% and ER, 82%/74%, respectively (log-rank-test = 0.23).CONCLUSIONS: Endovascular repair of RAA is as safe and effective as open repair in selected patients with appropriate anatomy. There was no difference in decline in renal function between OS and ER.
KW - Adult
KW - Aged
KW - Aneurysm/surgery
KW - Embolization, Therapeutic
KW - Endovascular Procedures/instrumentation
KW - Female
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Kaplan-Meier Estimate
KW - Linear Models
KW - Male
KW - Middle Aged
KW - Nephrectomy
KW - Renal Artery/surgery
KW - Reoperation/statistics & numerical data
KW - Retrospective Studies
KW - Stents
KW - Treatment Outcome
KW - Vascular Grafting
U2 - 10.1016/j.jamcollsurg.2013.03.021
DO - 10.1016/j.jamcollsurg.2013.03.021
M3 - SCORING: Journal article
C2 - 23769185
VL - 217
SP - 263
EP - 269
JO - J AM COLL SURGEONS
JF - J AM COLL SURGEONS
SN - 1072-7515
IS - 2
ER -
