Impact of aortic wall thrombus on late changes in renal function among patients treated by fenestrated-branched endografts

Giuliano de A. Sandri, Gustavo Oderich, Emanuel R. Tenorio, Mauricio S. Ribeiro, Leonardo Reis de Souza, Stephen S. Cha, Thanila A. Macedo, Stephen C Textor

Research output: Contribution to journalArticle

Abstract

Objective: Renal function deterioration is an important determinant of mortality in patients treated for complex aortic aneurysms. We have previously determined that catheter and guidewire manipulation in diseased aortas during fenestrated-branched endovascular aneurysm repair (F-BEVAR) is associated with risk of renal function deterioration. The aim of this study was to describe the impact of atherothrombotic aortic wall thrombus (AWT) on renal function deterioration among patients treated by F-BEVAR for pararenal and extent IV thoracoabdominal aortic aneurysms. Methods: Clinical data of 212 patients treated for complex aortic aneurysms with F-BEVAR were entered into a prospectively maintained database (2007-2015). AWT was evaluated by computed tomography angiography using volumetric measurements in nonaneurysmal aortic segments. AWT was classified as mild, moderate, or severe using objective assessment of the number of affected segments, thrombus type, thickness, area, and circumference. Acute kidney injury (AKI) was defined using Risk, Injury, Failure, Loss of kidney function, and End-stage renal disease (RIFLE) criteria, and renal function deterioration was defined by a decline in estimated glomerular filtration rate (eGFR) >30% from baseline. Patient survival and renal outcomes were assessed at dismissal, at 6 to 8 weeks, at 6 months, and annually, including AKI, serum creatinine concentration, eGFR, chronic kidney disease stage, need for renal replacement therapy, and presence of kidney infarction. Results: There were 169 male (80%) and 43 female (20%) patients with a mean age of 75 ± 7 years. Aneurysm extent was pararenal in 157 patients and extent IV thoracoabdominal aortic aneurysm in 55 patients. A total of 700 renal-mesenteric arteries were incorporated (3.1 ± 1 vessels/patient). AWT was classified as mild in 98 patients (46%), moderate in 75 (35%), and severe in 39 (19%). At 30 days, 45 patients (21%) developed AKI. Decline in eGFR and kidney infarction were associated with higher AWT volume index and severe AWT classification (P <.05). There was no association of AWT with 30-day mortality, which was 0.5% for the entire cohort. Mean follow-up was 29 ± 23 months. Freedom from renal function deterioration was 73% ± 6% for mild, 81% ± 6% for moderate, and 66% ± 8% for severe AWT patients at 3 years (P =.012) and 46% ± 9% and 82% ± 4% for those with or without AKI after the initial procedure (P <.001). Overall, 41 patients (19%) had progression of chronic kidney disease stage, but none of the patients required renal replacement therapy. Survival was 73% ± 5% for mild, 72% ± 6% for moderate, and 69% ± 10% for severe AWT patients at 3 years (P =.67). Conclusions: AWT is a significant predictor of AKI and continued decline in renal function after the initial F-BEVAR procedure. Longer follow-up time is needed to determine the actual impact of AWT on survival.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Thrombosis
Kidney
Acute Kidney Injury
Aneurysm
Glomerular Filtration Rate
Thoracic Aortic Aneurysm
Renal Replacement Therapy
Aortic Aneurysm
Chronic Renal Insufficiency
Infarction
Survival
Mesenteric Arteries
Mortality
Renal Artery
Chronic Kidney Failure
Renal Insufficiency
Aorta
Creatinine
Catheters
Databases

Keywords

  • Acute kidney injury (AKI)
  • Aortic wall thrombus (AWT)
  • Fenestrated-branched endovascular aneurysm repair (F-BEVAR)

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of aortic wall thrombus on late changes in renal function among patients treated by fenestrated-branched endografts. / Sandri, Giuliano de A.; Oderich, Gustavo; Tenorio, Emanuel R.; Ribeiro, Mauricio S.; Reis de Souza, Leonardo; Cha, Stephen S.; Macedo, Thanila A.; Textor, Stephen C.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Sandri, Giuliano de A. ; Oderich, Gustavo ; Tenorio, Emanuel R. ; Ribeiro, Mauricio S. ; Reis de Souza, Leonardo ; Cha, Stephen S. ; Macedo, Thanila A. ; Textor, Stephen C. / Impact of aortic wall thrombus on late changes in renal function among patients treated by fenestrated-branched endografts. In: Journal of Vascular Surgery. 2018.
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abstract = "Objective: Renal function deterioration is an important determinant of mortality in patients treated for complex aortic aneurysms. We have previously determined that catheter and guidewire manipulation in diseased aortas during fenestrated-branched endovascular aneurysm repair (F-BEVAR) is associated with risk of renal function deterioration. The aim of this study was to describe the impact of atherothrombotic aortic wall thrombus (AWT) on renal function deterioration among patients treated by F-BEVAR for pararenal and extent IV thoracoabdominal aortic aneurysms. Methods: Clinical data of 212 patients treated for complex aortic aneurysms with F-BEVAR were entered into a prospectively maintained database (2007-2015). AWT was evaluated by computed tomography angiography using volumetric measurements in nonaneurysmal aortic segments. AWT was classified as mild, moderate, or severe using objective assessment of the number of affected segments, thrombus type, thickness, area, and circumference. Acute kidney injury (AKI) was defined using Risk, Injury, Failure, Loss of kidney function, and End-stage renal disease (RIFLE) criteria, and renal function deterioration was defined by a decline in estimated glomerular filtration rate (eGFR) >30{\%} from baseline. Patient survival and renal outcomes were assessed at dismissal, at 6 to 8 weeks, at 6 months, and annually, including AKI, serum creatinine concentration, eGFR, chronic kidney disease stage, need for renal replacement therapy, and presence of kidney infarction. Results: There were 169 male (80{\%}) and 43 female (20{\%}) patients with a mean age of 75 ± 7 years. Aneurysm extent was pararenal in 157 patients and extent IV thoracoabdominal aortic aneurysm in 55 patients. A total of 700 renal-mesenteric arteries were incorporated (3.1 ± 1 vessels/patient). AWT was classified as mild in 98 patients (46{\%}), moderate in 75 (35{\%}), and severe in 39 (19{\%}). At 30 days, 45 patients (21{\%}) developed AKI. Decline in eGFR and kidney infarction were associated with higher AWT volume index and severe AWT classification (P <.05). There was no association of AWT with 30-day mortality, which was 0.5{\%} for the entire cohort. Mean follow-up was 29 ± 23 months. Freedom from renal function deterioration was 73{\%} ± 6{\%} for mild, 81{\%} ± 6{\%} for moderate, and 66{\%} ± 8{\%} for severe AWT patients at 3 years (P =.012) and 46{\%} ± 9{\%} and 82{\%} ± 4{\%} for those with or without AKI after the initial procedure (P <.001). Overall, 41 patients (19{\%}) had progression of chronic kidney disease stage, but none of the patients required renal replacement therapy. Survival was 73{\%} ± 5{\%} for mild, 72{\%} ± 6{\%} for moderate, and 69{\%} ± 10{\%} for severe AWT patients at 3 years (P =.67). Conclusions: AWT is a significant predictor of AKI and continued decline in renal function after the initial F-BEVAR procedure. Longer follow-up time is needed to determine the actual impact of AWT on survival.",
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author = "Sandri, {Giuliano de A.} and Gustavo Oderich and Tenorio, {Emanuel R.} and Ribeiro, {Mauricio S.} and {Reis de Souza}, Leonardo and Cha, {Stephen S.} and Macedo, {Thanila A.} and Textor, {Stephen C}",
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TY - JOUR

T1 - Impact of aortic wall thrombus on late changes in renal function among patients treated by fenestrated-branched endografts

AU - Sandri, Giuliano de A.

AU - Oderich, Gustavo

AU - Tenorio, Emanuel R.

AU - Ribeiro, Mauricio S.

AU - Reis de Souza, Leonardo

AU - Cha, Stephen S.

AU - Macedo, Thanila A.

AU - Textor, Stephen C

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Renal function deterioration is an important determinant of mortality in patients treated for complex aortic aneurysms. We have previously determined that catheter and guidewire manipulation in diseased aortas during fenestrated-branched endovascular aneurysm repair (F-BEVAR) is associated with risk of renal function deterioration. The aim of this study was to describe the impact of atherothrombotic aortic wall thrombus (AWT) on renal function deterioration among patients treated by F-BEVAR for pararenal and extent IV thoracoabdominal aortic aneurysms. Methods: Clinical data of 212 patients treated for complex aortic aneurysms with F-BEVAR were entered into a prospectively maintained database (2007-2015). AWT was evaluated by computed tomography angiography using volumetric measurements in nonaneurysmal aortic segments. AWT was classified as mild, moderate, or severe using objective assessment of the number of affected segments, thrombus type, thickness, area, and circumference. Acute kidney injury (AKI) was defined using Risk, Injury, Failure, Loss of kidney function, and End-stage renal disease (RIFLE) criteria, and renal function deterioration was defined by a decline in estimated glomerular filtration rate (eGFR) >30% from baseline. Patient survival and renal outcomes were assessed at dismissal, at 6 to 8 weeks, at 6 months, and annually, including AKI, serum creatinine concentration, eGFR, chronic kidney disease stage, need for renal replacement therapy, and presence of kidney infarction. Results: There were 169 male (80%) and 43 female (20%) patients with a mean age of 75 ± 7 years. Aneurysm extent was pararenal in 157 patients and extent IV thoracoabdominal aortic aneurysm in 55 patients. A total of 700 renal-mesenteric arteries were incorporated (3.1 ± 1 vessels/patient). AWT was classified as mild in 98 patients (46%), moderate in 75 (35%), and severe in 39 (19%). At 30 days, 45 patients (21%) developed AKI. Decline in eGFR and kidney infarction were associated with higher AWT volume index and severe AWT classification (P <.05). There was no association of AWT with 30-day mortality, which was 0.5% for the entire cohort. Mean follow-up was 29 ± 23 months. Freedom from renal function deterioration was 73% ± 6% for mild, 81% ± 6% for moderate, and 66% ± 8% for severe AWT patients at 3 years (P =.012) and 46% ± 9% and 82% ± 4% for those with or without AKI after the initial procedure (P <.001). Overall, 41 patients (19%) had progression of chronic kidney disease stage, but none of the patients required renal replacement therapy. Survival was 73% ± 5% for mild, 72% ± 6% for moderate, and 69% ± 10% for severe AWT patients at 3 years (P =.67). Conclusions: AWT is a significant predictor of AKI and continued decline in renal function after the initial F-BEVAR procedure. Longer follow-up time is needed to determine the actual impact of AWT on survival.

AB - Objective: Renal function deterioration is an important determinant of mortality in patients treated for complex aortic aneurysms. We have previously determined that catheter and guidewire manipulation in diseased aortas during fenestrated-branched endovascular aneurysm repair (F-BEVAR) is associated with risk of renal function deterioration. The aim of this study was to describe the impact of atherothrombotic aortic wall thrombus (AWT) on renal function deterioration among patients treated by F-BEVAR for pararenal and extent IV thoracoabdominal aortic aneurysms. Methods: Clinical data of 212 patients treated for complex aortic aneurysms with F-BEVAR were entered into a prospectively maintained database (2007-2015). AWT was evaluated by computed tomography angiography using volumetric measurements in nonaneurysmal aortic segments. AWT was classified as mild, moderate, or severe using objective assessment of the number of affected segments, thrombus type, thickness, area, and circumference. Acute kidney injury (AKI) was defined using Risk, Injury, Failure, Loss of kidney function, and End-stage renal disease (RIFLE) criteria, and renal function deterioration was defined by a decline in estimated glomerular filtration rate (eGFR) >30% from baseline. Patient survival and renal outcomes were assessed at dismissal, at 6 to 8 weeks, at 6 months, and annually, including AKI, serum creatinine concentration, eGFR, chronic kidney disease stage, need for renal replacement therapy, and presence of kidney infarction. Results: There were 169 male (80%) and 43 female (20%) patients with a mean age of 75 ± 7 years. Aneurysm extent was pararenal in 157 patients and extent IV thoracoabdominal aortic aneurysm in 55 patients. A total of 700 renal-mesenteric arteries were incorporated (3.1 ± 1 vessels/patient). AWT was classified as mild in 98 patients (46%), moderate in 75 (35%), and severe in 39 (19%). At 30 days, 45 patients (21%) developed AKI. Decline in eGFR and kidney infarction were associated with higher AWT volume index and severe AWT classification (P <.05). There was no association of AWT with 30-day mortality, which was 0.5% for the entire cohort. Mean follow-up was 29 ± 23 months. Freedom from renal function deterioration was 73% ± 6% for mild, 81% ± 6% for moderate, and 66% ± 8% for severe AWT patients at 3 years (P =.012) and 46% ± 9% and 82% ± 4% for those with or without AKI after the initial procedure (P <.001). Overall, 41 patients (19%) had progression of chronic kidney disease stage, but none of the patients required renal replacement therapy. Survival was 73% ± 5% for mild, 72% ± 6% for moderate, and 69% ± 10% for severe AWT patients at 3 years (P =.67). Conclusions: AWT is a significant predictor of AKI and continued decline in renal function after the initial F-BEVAR procedure. Longer follow-up time is needed to determine the actual impact of AWT on survival.

KW - Acute kidney injury (AKI)

KW - Aortic wall thrombus (AWT)

KW - Fenestrated-branched endovascular aneurysm repair (F-BEVAR)

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