SP344LONG TERM RENAL FUNCTION AFTER ENDOVASCULAR ANEURYSM REPAIR

Abstract

Introduction and Aims: Endovascular repair (EVAR) is a common treatment for abdominal aortic aneurysm (AAA) which has become the first‐line option in most centres. It is now routinely offered in younger patients with AAA. However, its long term effects on renal function remain unknown, especially in comparison with similar populations. The aim of this study was to assess long term renal dysfunction after EVAR using a contemporary estimate of glomerular filtration rate (eGFR). Methods: A multicentre case control study was performed. Overall, 1,894 patients were included: 947 patients [7.4% females, age: 71+/‐8 (SD) years, AAA‐size: 6.1+/‐1.3cm] undergoing elective EVAR of an infrarenal AAA and 947 patients undergoing treatment of carotid artery stenosis [670 carotid endarterectomies (CEAs) and 277 carotid stenting (CAS)]. These patients were case matched at baseline for age (within 5 years) and stage of chronic kidney disease (CKD). eGFR levels were compared at baseline and 5 years after treatment. For the EVAR cohort, changes in eGFR were also assessed (CKD‐EPI formula) at 30 days, 1, and 2 years. Results: The two groups did not differ at baseline with regards to age (71+/‐8 versus 73 +/‐12 years, p=0.32), history of prior cardiovascular disease (15% versus 19%, p=0.14) and eGFR (72+/‐20 versus 79+/‐24 ml/min/1.73m2, p=0.09). For EVAR, eGFR declined from 72+/‐20 ml/min/1.73m2 to 61+/‐27 units at 5 years (p<0.001), which is an average decline of 11 units. For the carotid disease patients, eGFR declined from 79+/‐24 to 72 +/‐17 units (p<0.001), an average decline of 7 units. The majority of loss of renal function for the EVAR patients occurred within the 1st year (79%) after the elective repair. Conclusions: Elective EVAR leads to a significant decline in eGFR after 5 years, which is more pronounce compared to a population with similar characteristics and risk factors. Most of that loss in renal function occurs during the first year. Perioperative renoprotective strategies are required in this population.