Renal Artery Interventions During Infrarenal Endovascular Aortic Repair: A Greater Potential of Subsequent Failure?

Purpose: To determine the anatomic and functional outcomes of renal artery interventions during endovascular aortic aneurysm repair (EVAR) and compare them with renal artery interventions without EVAR. Materials and Methods: A renal artery revascularization database (1987-2007) was reviewed to identify patients who underwent renal intervention during EVAR and those who had an intervention in the absence of EVAR. Outcomes were analyzed with respect to patient comorbidities, renal anatomy and function, procedural events, and postoperative complications. Results: A total of 413 patients (239 men; 58%) underwent 589 renal artery revascularizations (51 with EVAR and 362 without). Mean age was 70 years ± 10. Mean follow-up was 3.5 years (range, 1-13 y). Primary indications for renal intervention were hypertension (63%) and elevated creatinine level (27%). The EVAR group was more likely to incur an increased creatinine level at 1 month after intervention (33% vs 18%; P = .007). Freedom from restenosis was similar (P = .501), but arterial occlusion rate was higher in the EVAR group (96% ± 3% vs 100% ± 10% cumulative patency at 3 y; P = .005). At 3 years, freedom from recurrent symptoms (P = .26), freedom from adverse renal events (P = .12), and survival (85% ± 8% vs 75% ± 2%; P = .83) were not significantly different. Conclusions: Renal artery revascularization during EVAR should be considered higher risk because of the high incidence of procedural complications, early functional injury, and early occlusion rates. However, the long-term sequelae and benefits of such a procedure are similar to those of a renal revascularization procedure in the absence of EVAR.