Outcomes of Small Renal Artery Targets in Patients Treated by Fenestrated-Branched Endovascular Aortic Repair
| Autor: | Keouna Pather, Bernardo C. Mendes, Emanuel R. Tenorio, Alisa Diderrich, Jean Wigham, Gustavo S. Oderich, Jussi M. Kärkkäinen, Thanila A. Macedo |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Computed Tomography Angiography Operative Time 030204 cardiovascular system & hematology 030230 surgery Kidney Aortic repair Accessory renal artery Blood Vessel Prosthesis Implantation 03 medical and health sciences Postoperative Complications Renal Artery 0302 clinical medicine medicine.artery medicine Humans In patient Prospective Studies Renal artery Vascular Patency Aged Computed tomography angiography Aged 80 and over Aortic Aneurysm Thoracic Rupture Spontaneous medicine.diagnostic_test business.industry Endovascular Procedures Middle Aged Treatment Outcome Female Stents Surgery Radiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 59:910-917 |
| ISSN: | 1078-5884 |
| Popis: | The aim was to evaluate renal related outcomes in patients who had incorporation of a small (4.0 mm) renal artery (RA) during fenestrated-branched endovascular aortic repair (F-BEVAR).A total of 215 consecutive patients enrolled in a prospective F-BEVAR trial were reviewed. Computed tomography angiography centreline of flow reconstruction was used to measure mean RA diameter. Patients who had at least one4.0 mm main or accessory RA incorporated by fenestration or directional branch (study group) were compared with patients who had incorporation of two ≥5.0 mm RAs (control group). Endpoints were technical success of RA incorporation, RA rupture and kidney loss, primary and secondary RA patency, RA branch instability and re-interventions, and renal function deterioration.Twenty-four patients with 28 4.0 mm RAs (16 accessory and 12 main RAs) were compared with 144 patients with 288 ≥5.0 mm incorporated RAs. Study group patients were significantly younger than controls (72 ± 8 vs. 75 ± 8 years, p = .04) and more often females (46% vs. 21%, p = .018); there were no differences in cardiovascular risk factors and aneurysm extent. Technical success was 92% for4.0 mm and 99% for ≥5.0 mm RA incorporation (p = .05). Inadvertent RA rupture occurred in three patients in the study group (13%) and in one (1%) in the control group (p = .009) resulting in kidney loss in two study group patients (8%) and one (1%) control group patient (p = .05). At one year, primary patency was 79 ± 9% vs. 94 ± 1% (p .001) and secondary patency was 84 ± 8% vs. 97 ± 1% (p .001) for study vs. control group; freedom from branch instability was 79 ± 9% vs. 93 ± 2% (p = .005), respectively. There were no differences in re-intervention rates and renal function deterioration between the groups. The mean follow up time was 21 ± 14 months.Incorporation of4.0 mm RAs during F-BEVAR is associated with lower technical success, higher risk of arterial disruption and kidney loss, and lower patency rates at one year. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect