Transrenal fixation of aortic stent-grafts for the treatment of infrarenalaortic aneurysmal disease

Citation
Pg. Bove et al., Transrenal fixation of aortic stent-grafts for the treatment of infrarenalaortic aneurysmal disease, J VASC SURG, 32(4), 2000, pp. 697-702
Citations number
4
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF VASCULAR SURGERY
ISSN journal
0741-5214 → ACNP
Volume
32
Issue
4
Year of publication
2000
Pages
697 - 702
Database
ISI
SICI code
0741-5214(200010)32:4<697:TFOASF>2.0.ZU;2-D
Abstract
Purpose: We evaluated our early experience with the transrenal fixation of aortic stent-grafts to determine the efficacy of this procedure and its eff ects on renal artery patency and hemodynamics. Methods: Twenty-eight patients (22 men) had endoluminally placed modular bi furcated stent-grafts with a bare spring structure at the proximal end cros sing the origin of both renal arteries; no patient with infrarenal fixation was included for analysis. The mean age of the patients was 75 +/- 7 years (range, 58-86 years); the mean aneurysm size was 5.8 0.8, (range, 4.7-7.2 cm). Eight patients had preoperative or intraoperative angiographic evidenc e of renal artery atherosclerotic disease, but only four vessels had lumina l narrowing of 50% or greater. No complications were noted during stent-gra ft placement, and all patients have returned for follow-up visits, ranging from 1 to 12 months (mean followup, 6 +/- 4 months). Follow-up evaluations included clinical assessment, duplex ultrasound scan of the renal arteries and kidneys, and computed tomographic angiography. Results: No evidence of lobular or sublobular perfusion defects of the rena l parenchyma was detected postoperatively. Two patients exhibited postopera tive changes in renal artery hemodynamics-one progressing from a 30% diamet er reduction to a greater than 60% diameter stenosis at the 12-month follow -up visit and one with a normal renal artery preoperatively having elevated flow velocities indicative of a greater than 60% stenosis at the 1-month v isit. Of 19 patients with normal preoperative renal function, only one has had persistently elevated serum creatinine levels. Conclusion: We conclude from this experience that the transrenal placement of open stents is safe and effectively excludes the aneurysm, potentially e xpanding the availability of this technique to more patients with a short i nfrarenal aortic neck. Long-term follow-up is essential to determine the ov erall efficacy of this technique and to identify potential effects on renal artery hemodynamics or kidney function.