Meta-analysis links suprarenal aortic repair techniques to higher risk of permanent renal dialysis in AAA patients

OBJECTIVE: To quantify the risk of permanent renal dialysis following abdominal aortic aneurysm (AAA) repair, comparing suprarenal and infrarenal, and open and endovascular aortic repairs (EVAR). DATA SOURCES: MEDLINE, Embase, and CENTRAL searches, including primary elective AAA repair for minimum 100 patients, published from 2010. REVIEW METHODS: Systematic review, meta-analysis, and meta-regression of post-operative permanent dialysis following PRISMA guidelines (PROSPERO: CRD42021272422). RESULTS: Fifty-six studies, 72 803 AAAs: 57 708 infrarenal EVARs, (1 738 infrarenal fixation and 2 963 suprarenal fixation EVARs,) 1 159 complex EVARs, 9 108 infrarenal and 4 828 suprarenal open repairs. Low rates of permanent dialysis were reported: 0.42% (95%CI 0.22-0.62%) infrarenal EVAR, (0.12% [0-0.37%] infrarenal fixation, 0.70% [0.25-1.14%] suprarenal fixation,) 1.61% (0.65-2.57%) complex EVAR, 0.28% (0.03-0.53%) infrarenal open and 0.98% (0.49-1.46%)] suprarenal open aortic repair. No significant difference in permanent dialysis between open repair and EVAR was observed for infrarenal or suprarenal repairs. Increased risk was observed for suprarenal fixation compared with infrarenal fixation EVAR (odds ratio 2.38 [1.19-4.78]) and suprarenal compared with infrarenal open aortic repair (odds ratio 3.29 [2.07-5.25]). Increasing patient age, female sex, and greater contrast dose were associated with permanent dialysis. GRADE criteria confidence for all estimates were low or very low. CONCLUSION: Rates of permanent dialysis were generally <1% for infrarenal AAA repair. Surgeons should advise patients undergoing suprarenal manipulation (suprarenal fixation or clamping) of enhanced risk.