The impact of trans-renal aortic endograft fixation on renal function and the role of NGAL in the management of abdominal aortic aneurysms

Abstract

Over the last 20 years endovascular aneurysm repair (EVAR) has advanced dramatically. Early devices incorporated infra-renal fixation (IR), and were prone to delayed mechanical failure. Later devices incorporated bare metal stents that deploy in the supra-renal aorta (SR), improving durability, but potentially affecting long term renal function. This is the subject of continued research. Cystatin C (CC) is a low molecular weight protein, which has demonstrated great sensitivity at detecting renal dysfunction, despite only modest decreases in glomerular filtration rate (GFR). To date it has not been used to evaluate mid to long term renal function following EVAR. Neutrophil gelatinase associated lipocalin (NGAL) is a member of the lipocalin family of proteins, and rises considerably following renal insult due to surgery or nephro-toxicity. With increasing numbers of abdominal aortic aneurysm (AAA) repairs, it’s important to have a reliable indicator and predictor of potential renal dysfunction following surgery.