Long-Term Renal Function Decline is Associated With Higher Contrast Volume Administration After Endovascular Aortic Aneurysm Repair Compared to Patients With Peripheral Arterial Disease

Background: The impact of endovascular aortic aneurysm repair (EVAR) in subsequent renal dysfunction is unclear. We compared EVAR patients to those with disabling claudication or critical limb-threatening ischemia to discern long-term renal outcomes. Methods: Retrospective analysis of consecutive patients who underwent EVAR or angiography for symptomatic lower extremity arterial occlusive disease (peripheral arterial disease [PAD]) from July 2006 to July 2013, propensity-matched for diabetes, hypertension, smoking history, chronic kidney disease stage, age, sex, and race. Results: Cohorts of 214 propensity-matched EVAR and PAD patients were generated with median follow-up of 8.4 years. There were similar rates of subsequent dialysis dependence (1.4% vs. 2.3%, P = 0.502) and mortality (41.8% vs. 40.4%, P = 0.627), but more contrast studies and higher contrast volumes in EVAR patients (6.0 vs. 3.0, P < 0.001; 665 mL vs. 420 mL, P < 0.0001). In EVAR patients, glomerular filtration rate was stable and not different from PAD patients until 9 years of follow-up, when EVAR patients showed a significant decline in renal function. Additional propensity-matched cohorts of 104 EVAR patients with suprarenal or infrarenal fixation showed no significant differences in change in renal function over time. Conclusion: The significant, sustained relative deterioration in glomerular filtration rate seen after 9 years in EVAR patients compared to propensity-matched PAD patients may potentially be explained by the higher number of contrast studies and contrast volumes administered to EVAR patients over time. Suprarenal fixation does not appear to negatively impact long-term renal function compared with infrarenal fixation. As per Society for Vascular Surgery recommendations, contrast studies should be used judiciously for long-term surveillance of aortic endografts.