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Preoperative Proteinuria is Associated with Higher Mortality After Fenestrated/Branched Aortic Repair of Complex Anatomy Aortic Aneurysms
Vivian Carla Gomes, F. Ezequiel Parodi, Priya Vasan, William A. Marston, Luigi Pascarella, Katharine L. McGinigle, Jacob C. Wood, Ehsan Benrashid, Mark A. Farber
University of North Carolina, Chapel Hill, NC
Background: Previous literature demonstrated association between preoperative proteinuria and mortality after endovascular repair of juxtarenal aortic aneurysms. The aim of this study is to evaluate the association of preoperative proteinuria on 1- and 5-year survival post fenestrated/branched endovascular repair (F/BEVAR) of thoracoabdominal aortic aneurysms (TAAA), pararenal (PRAA) and juxtarenal aortic aneurysms (JRAA) treated with company-manufactured (CMD) or off-the-shelf (OTS) devices. The impact on kidney function post-F/BEVAR was also analyzed.
Methods: A retrospective analysis was performed with prospectively collected data, including patients with complex anatomy aortic aneurysms who underwent F/BEVAR at a single institution from July 2012 to February 2024. All patients were treated with a CMD or OTS device under a PS-IDE protocol. Patients were divided into 2 groups based on the preoperative urinalysis performed within 30 days before the index procedure: patients with trace or no proteinuria
vs patients with proteinuria (1+:30-100 mg/dL; 2+:100-299 mg/dL; 3:≥300 mg/dL). Primary outcomes were 1-year and 5-year survival. Secondary outcomes were 30-day mortality, myocardial infarction (MI), stroke/ transient ischemic attack (TIA), acute kidney injury (AKI), and spinal cord ischemia (SCI). The follow-up protocol included imaging studies (chest, abdomen and pelvis angio CT, abdominal radiography, and renal-mesenteric duplex ultrasound) and laboratory analysis. Time-to-event analysis was performed with Kaplan Meier plots compared through log-rank test. Binary logistic regression model was designed to investigate predictors associated with 5-year survival post F/BEVAR.
Results: A total of 454 patients underwent F/BEVAR procedure, and were: 71.5% males, 15.4% black, with mean age of 72 ± 5.2 years. Sixty-seven (14.7%) patients had preoperative proteinuria ≥ 30 mg/dL. Patients with and without preoperative proteinuria were similar in terms of demographics, aneurysm extension, and comorbidities, with the exception of chronic kidney disease that, as expected, was more prevalent in patients with proteinuria (P <0.001). There was no significant difference observed in 30-day mortality, AKI, SCI, stroke/TIA or MI. The survival analysis demonstrated a significantly lower 1-year (77.9 ± 5.4%
vs 89.4 ± 1.6%, P=0.004) and 5-year survival (33.8 ± 8.8%
vs 65.2 ± 3%. P = 0.002 - Figure 1) among the patients with proteinuria when compared with individuals presenting trace or no proteinuria. Patients with preoperative proteinuria had a risk of death almost two times higher (OR:1.95, 5% CI:1.27 - 2.99, P=0.002) and risk of developing kidney failure requiring dialysis at 5 years more than eight times higher (OR:8.28, 95% CI:2.62-26.13, P=<0.001). Proteinuria was a better predictor of mortality than preoperative eGFR< 60 mL/min/1.73m2, which was not significantly associated with this adverse event (P=0.060).
Conclusion: The presence of significant proteinuria preoperatively is associated with reduced 1 and 5 year survival after F/BEVAR procedure in patients undergoing repair for thoracoabdominal, pararenal or juxtarenal aortic aneurysms. Preoperative proteinuria can be used to aid in preoperative risk assessment of either survival or kidney function deterioration after F/BEVAR.
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