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Published online before print May 23, 2006, 10.1148/radiol.2401050134
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(Radiology 2006;240:65-72.)
© RSNA, 2006

Evidence-based Practice

Transrenal Fixation of Aortic Stent-Grafts: Short- to Midterm Effects on Renal Function—A Systematic Review1

Zhonghua Sun, PhD and Gil Stevenson, MSc, CStat

1 From the School of Health Sciences, University of Ulster, Newtownabbey, Northern Ireland, UK (Z.S.); and Real Statistics, Bangor, Count Down, Northern Ireland (G.S.). Received January 27, 2005; revision requested March 31; revision received June 27; accepted July 20; final version accepted September 1. Address correspondence to Z.S., Department of Medical Imaging Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845 (e-mail: z.sun{at}curtin.edu.au).

Purpose: To perform a systematic review of the short- to midterm effects of transrenal fixation of aortic stent-grafts on renal function in patients with abdominal aortic aneurysms.

Materials and Methods: A search of the PubMed, MEDLINE, and EMBASE databases for English-language literature was performed. Studies with at least 10 patients were included for data analysis. Only studies on transrenal fixation of aortic stent-grafts that included follow-up results for renal function were included. A log-linear model was used for meta-analysis to compare transrenal fixation with infrarenal fixation.

Results: Twenty-two studies met the inclusion criteria. Because two studies analyzed the same group of patients, one was excluded, for a total of 21 studies. Comparisons between transrenal fixation and infrarenal fixation were found in seven studies. For transrenal versus infrarenal fixation, the combined odds ratio, 95% confidence interval, and P value were found to be statistically significant with respect to postprocedural renal infarction only (combined odds ratio, 5.189; 95% confidence interval: 3.198, 8.420; P < .001). No significant difference was found between transrenal and infrarenal fixation with respect to renal dysfunction, renal artery occlusion, or endoleaks (P > .05).

Conclusion: Transrenal fixation of aortic stent-grafts seems to be a relatively safe alternative compared with infrarenal fixation in terms of short- to midterm follow-up. Postprocedural renal infarction, however, was significantly higher for transrenal fixation.

© RSNA, 2006