Long-term Renal Function Decline is Associated with Higher Contrast Volume Administration after Endovascular Aortic Aneurysm Repair Compared to Patients with Peripheral Arterial Disease

Graham W Long; Mohineesh Kumar; Diane M Studzinski; Rose E Callahan; O William Brown

doi:10.1016/j.avsg.2025.06.013

Long-term Renal Function Decline is Associated with Higher Contrast Volume Administration after Endovascular Aortic Aneurysm Repair Compared to Patients with Peripheral Arterial Disease

Ann Vasc Surg. 2025 Jun 17:S0890-5096(25)00422-4. doi: 10.1016/j.avsg.2025.06.013. Online ahead of print.

Authors

Graham W Long¹, Mohineesh Kumar², Diane M Studzinski³, Rose E Callahan³, O William Brown⁴

Affiliations

¹ Department of Surgery, Section of Vascular Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan. Electronic address: Graham.Long@corewellhealth.org.
² Department of Surgery, Section of Vascular Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
³ Department of Surgery, Section of Vascular Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan; Corewell Health Research Institute, Royal Oak, Michigan.
⁴ Department of Surgery, Section of Vascular Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan.

PMID: 40553845
DOI: 10.1016/j.avsg.2025.06.013

Abstract

Introduction: 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 (PAD) from July 2006-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% versus 2.3%, P = 0.502) and mortality (41.8% versus 40.4%, P = 0.627), but more contrast studies and higher contrast volumes in EVAR patients (6.0 versus 3.0, P < 0.001; 665mL vs 420mL, P < .0001). In EVAR patients, glomerular filtration rate (GFR) 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 GFR 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. Per Society for Vascular Surgery recommendations, contrast studies should be used judiciously for long-term surveillance of aortic endografts.

Keywords: Abdominal aortic aneurysm; Chronic renal failure; Computed tomography scan; Dialysis dependence; Endovascular aortic aneurysm repair; Peripheral arterial disease.