EVAR Boosts Renal Intervention Risk

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Patients who have had an endovascular aneurysm repair more likely to suffer arterial occlusion.

 

WASHINGTON, D.C.—Patients with an endovascular aneurysm repair (EVAR) should be considered a high-risk group for renal artery interventions and receive closer post-procedure surveillance.

 

Researchers at the University of Rochester in New York studied 413 patients who underwent 583 renal interventions (51 EVAR and 482 non-EVAR patients). Among the 413 patients, 239 were male (58%) and the mean age was 84 years. A total of 18% had angioplasty alone, 47% had stenting alone, and 35% had a combination of angioplasty and stenting of the lesion. The mean follow-up was 3.5 years (range, 0-14 years).

 

The primary indications for intervention were hypertension (63%) and elevated creatinine levels (27%). Peri-operative mortality was 7% with no significant difference between the two groups (EVAR versus non-EVAR). Patients with an EVAR were more likely to incur an immediate increase in creatinine levels at one month post-procedure (33% vs. 18%).

 

During follow-up, restenosis rates in both groups were similar, but the rate of arterial occlusion was higher in the EVAR group. The 30-day occlusion rates were 4% in the EVAR group and 0% in the non-EVAR group. There were no “immediate” occlusions in the non-EVAR group, but there were two in the EVAR group.

 

EVAR patients tended to be older and more likely to be asymptomatic. These patients experienced higher morbidity and occluded at a higher rate, but had similar clinical outcomes.

More studies are needed, but “we think it is important for urologists and nephrologists to be aware of what we did find,” said lead investigator Clinton Protack, MD, who conducted the study when he was a fourth-year medical student. “They should be aware that patients undergoing renal artery revascularization procedures, and who are also undergoing EVAR at the same time, are more likely to have a vessel occlusion during follow-up. So, they need to be monitored more closely.”

 

The overall morbidity rate was 12%. The EVAR group had a higher complication rate than the non-EVAR group (24% vs. 10%). For the study population as a whole, the complications included hematoma (4% of patients), pseudoaneurysm development (3%), stent dislodgement (2%), embolization (2%), acute dissection (2%), hemorrhage (2%), perforation (1%), and fistula formation (1%).

 

Findings were reported here at the Society of Interventional Radiology annual meeting.

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