Open and endovascular treatment by covered and multilayer stents in the therapy of renal artery aneurysms: mid and long term outcomes in a single center experience
| Autor: | Ben Hamida J, Berloco Pb, Luigi Irace, R Stumpo, Francesco Giosuè Irace, R. Gattuso, Bruno Gossetti, S. Venosi, Ombretta Martinelli |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Prosthesis Design Open surgery Single Center Covered stent Endovascular Multilayer stent Renal artery aneurysm Surgery Young Adult 03 medical and health sciences Renal Artery 0302 clinical medicine Aneurysm medicine.artery 0502 economics and business medicine Humans cardiovascular diseases Renal artery Endovascular treatment Aged business.industry Endovascular Procedures 05 social sciences Middle Aged medicine.disease Thrombosis Autotransplantation Nephrectomy Treatment Outcome Blood pressure Original Article Female Stents 050211 marketing business Vascular Surgical Procedures |
| Zdroj: | Giornale di Chirurgia - Journal of Surgery. 38:219 |
| ISSN: | 1971-145X |
| DOI: | 10.11138/gchir/2017.38.5.219 |
| Popis: | AIM The purpose of this paper is to evaluate the mid and long terms outcomes of open and endovascular surgical treatment, as well as multilayer stent, in patients affected by Renal Artery Aneurysm (RAA). PATIENTS AND METHODS Twenty five patients with RAA (24 monolateral and 1 bilateral aneurysm, 26 aneurysms) were observed between 2000 and 2015: 4 were not treated due to the small size of the aneurysm (< 2.5 cm); out of the remaining, 16 underwent endovascular treatment, 2 were treated by open surgery consisting in aneurysmectomy and graft reconstruction and 5 (in 1 patient bilateral) were treated by ex vivo repair and autotransplantation. RESULTS Out of the 22 patients treated for RAA, one patient operated upon open surgery presented an early thrombosis of a PTFE graft, followed by nephrectomy (4.7%); one patient underwent autotransplantation showed an ureteral kinking without functional consequences. In a follow-up ranging from 1 and 11 years (mean 5 years), no deaths were observed; all the renal arteries repaired were patents and 16 out of 21 patients had a significative reduction of systemic blood pressure. DISCUSSION The choice of the best treatment is based on aneurysm's morphology according to Rundback's classification. The type I, involving the main renal artery, is always treated by endovascular approach; type II, involving renal artery bifurcations may be treated by open surgery or multilayer stents; type III (hilar or intraparenchymal aneurysms) needs only an open surgical treatment as autotransplantation. CONCLUSION Based on our experience it seems that most of RAAs may be treated by endovascular technique. The ex vivo autotransplantation represents the first-line treatment in hilar and intraparenchymal aneurysms. Multilayer stents seem to have good outcome in the treatment of aneurysms involving arterial bifurcations. Mid and long term results, related to kidney preservation and to normalization of blood pressure, seems satisfying. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|