scholarly journals The “Open” Chimney Graft Technique for Juxtarenal Aortic Aneurysms with Discrepant Renal Arteries

2014 ◽  
Vol 47 (2) ◽  
pp. 124-130 ◽  
Author(s):  
E. Ducasse ◽  
S. Lepidi ◽  
C. Brochier ◽  
S. Deglise ◽  
X. Berard ◽  
...  
Keyword(s):  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Chimney Graft

scholarly journals The “Open” Chimney Graft Technique for Juxtarenal Aortic Aneurysms with Discrepant Renal Arteries

2014 ◽  
Vol 59 (2) ◽  
pp. 556
Author(s):  
E. Ducasse ◽  
S. Lepidi ◽  
C. Brochier ◽  
S. Deglise ◽  
X. Berard ◽  
...  
Keyword(s):  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Chimney Graft

Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs

2016 ◽  
Vol 24 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Marwan Youssef ◽  
Sebastian Zerwes ◽  
Rudolf Jakob ◽  
Oroa Salem ◽  
Fritz Dünschede ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Multiple Organ ◽  
Aortic Aneurysms ◽  
Technical Success ◽  
Graft Thrombosis ◽  
Type Ia ◽  
Aneurysm Repair ◽  
Chimney Graft ◽  
Bifurcated Graft

Purpose: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR). Methods: Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5–11). Eight patients were treated on an urgent or emergency basis (6 symptomatic aneurysms and 2 contained ruptures). All patients underwent Nellix relining of the failed stent-graft; 10 had chimney (Ch) procedures in combination with EVAS (chEVAS) because the proximal landing zones were inadequate. Results: Technical success was 100%. All endoleaks were successfully sealed, and no additional intervention was required. No further endoleak after EVAS or chEVAS was recorded. Endobag protrusion occurred in 1 case without sequelae. One elderly patient with ruptured aneurysm died from multiple organ failure 2 months postoperatively. One renal artery guidewire injury led to nephrectomy because of active bleeding. No reinterventions, aneurysm-related mortalities, graft thrombosis, endoleaks, or chimney graft occlusions were observed during a median follow-up of 8 months (range 3–24). Conclusion: The present preliminary experience demonstrates that the use of EVAS/chEVAS is feasible for treatment of failed EVAR. This technique may be used as bailout or an alternative treatment when other established methods are infeasible or not available.

scholarly journals EndoAnchors Minimize Endoleaks in Chimney-Graft Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms

2019 ◽  
Vol 46 (3) ◽  
pp. 183-188 ◽  
Author(s):  
Edgar Luis Galiñanes ◽  
Eduardo A. Hernandez-Vila ◽  
Zvonimir Krajcer
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Graft Thrombosis ◽  
Complex Anatomy ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Type Ia ◽  
Aneurysm Repair ◽  
Chimney Graft

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11–18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.

Cardiac Pulsatility– and Respiratory-Induced Deformations of the Renal Arteries and Snorkel Stents After Snorkel Endovascular Aneurysm Sealing

2019 ◽  
Vol 26 (4) ◽  
pp. 556-564
Author(s):  
Christopher P. Cheng ◽  
Ga-Young Suh ◽  
John J. Kim ◽  
Andrew Holden
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Left Renal Artery ◽  
3 Dimensional ◽  
Maximum Curvature ◽  
Mechanical Durability ◽  
The Right ◽  
Aneurysm Repair

Purpose: To quantify deformations of renal arteries and snorkel stents after snorkel endovascular aneurysm sealing (Sn-EVAS) resulting from cardiac pulsatility and respiration and compare these deformations to patients with untreated abdominal aortic aneurysms (AAA) and snorkel endovascular aneurysm repair (Sn-EVAR). Materials and Methods: Ten Sn-EVAS patients (mean age 75±6 years; 8 men) were scanned with cardiac-gated, respiration-resolved computed tomography angiography. From 3-dimensional geometric models, changes in renal artery and stent angulation and curvature due to cardiac pulsatility and respiration were quantified. Respiration-induced motions were compared with those of 16 previously reported untreated AAA patients and 11 Sn-EVAR patients. Results: Renal artery bending at the stent end was greater for respiratory vs cardiac influences (6°±7° vs −1°±2°, p<0.025). Respiration caused a 3-fold greater deformation on the left renal artery as compared with the right side. Maximum curvature change was higher for respiratory vs cardiac influences (0.49±0.29 vs 0.24±0.17 cm−1, p<0.025), and snorkel renal stents experienced similar maximum curvature change due to cardiac pulsatility and respiration (0.14±0.10 vs 0.19±0.09 cm−1, p=0.142). When comparing the 3 patient cohorts for respiratory-induced deformation, there was significant renal branch angulation in untreated AAAs, but not in Sn-EVAR or Sn-EVAS, and there was significant bending at the stent end in Sn-EVAR and Sn-EVAS. Maximum curvature change due to respiration was ~10-fold greater in Sn-EVAR and Sn-EVAS compared to untreated AAAs. Conclusion: The findings suggest that cardiac and respiratory influences may challenge the mechanical durability of snorkel stents of Sn-EVAS; similarly, however, respiration may be the primary culprit for tissue irritation, increasing the risk for stent-end thrombosis, especially in the left renal artery. The bending stiffness of snorkel stents in both the Sn-EVAR and Sn-EVAS cohorts damped renal branch angulation while it intensified bending of the artery distal to the snorkel stent. Understanding these device-to-artery interactions is critical as they may affect mechanical durability of branch stents and quality and durability of treatment.

Abstract 228: Histology and Pathophysiology Study of Renal Aneurysm

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Bertrand Chavent ◽  
Batool Arif ◽  
Terri Ennis ◽  
John A Curci
Keyword(s):  
Statistical Significance ◽  
Gelatin Zymography ◽  
Inflammatory Cells ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Elastin Degradation ◽  
Renal Aneurysm ◽  
The Media ◽  
End Stage ◽  
Alpha Actin

Objectives: While progress has been made over the past 2 decades in our understanding of the development of abdominal aortic aneurysms (AAA), far less is understood about the development and pathobiology of aneurysms of the renal arteries. A valuable collection of renal artery tissue collected over the course of many years was used to directly compare histology, as well as some known mediators of AAA development in end-stage tissue from renal arteries aneurysm (RAA) and AAA. Methods: Tissues were collected and stored (frozen fresh and FFPE) at the time of aneurysm repair or renal transplant for normal aortic specimens. Histologic morphometry was performed to quantify elastin staining and immunohistochemistry for CD68, alpha-actin, MMP9 and Osteopontin (OPN). Gelatin zymography was performed on protein extracts from the tissues. Results: All aneurysms (AAA, n=9, RAA, n=9) tissues demonstrated a significantly (P<0.05) reduced percentage of mural elastin than that seen in normal aorta (16.3±3.4%, n=5). Loss of medial elastin was nearly complete in AAA (.11±.04%). Elastin in all RAA was substantially greater (3.6±1.4%) than AAA but this did not reach statistical significance (P=0.1). Elastin content is significantly greater in RAA due to fibromuscular dysplasia (RAA-FMD, n=5, 6.6±1.8%) than AAA (P<. 02) and idiopathic RAA (iRAA, 0.72±0.48%, P<.03). RAA had greater preservation of smooth muscle cell (SMC) mass in the aortic wall, and unlike AAA, the cells were in typical laminar formation in the media. Few macrophages were seen in any RAA tissue. By immunohistology, qualitatively there is substantially greater OPN in all RAA. There was also very little immunreactive MMP-9 in the RAA specimens, whereas AAA specimens had substantial MMP-9 present in inflammatory cells and SMC. MMP9 activity on zymography was found to be significantly lower in RAA (n=3) than in AAA (n=3; p=0.03). Conclusions: These important and unique studies demonstrate that the histology and general pathobiology of RAA is distinct from AAA. Elastin degradation is significantly lower in RAA, particularly in RAA-FMD. Infiltrating macrophages and elastolytic enzyme MMP-9 appear to play a relatively small role in the development of RAA.

Fenestrated and Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysm With More Than 4 Target Visceral Vessels due to Renovisceral Arterial Anatomical Variations: Feasibility and Early Results

2021 ◽  
pp. 152660282110164
Author(s):  
Ahmed Eleshra ◽  
Giuseppe Panuccio ◽  
Konstantinos Spanos ◽  
Fiona Rohlffs ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Anatomical Variations ◽  
Celiac Artery ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Technical Success ◽  
Early Results ◽  
The Mean ◽  
Accessory Renal Arteries

Purpose: This study describes technical success, feasibility, and early results of fenestrated and branched endovascular aortic repair (F/B-EVAR) for treatment of thoracoabdominal aortic aneurysms (TAAAs) or pararenal aneurysms with more than 4 target visceral vessels (TVs) due to renovisceral arterial anatomical variations. Materials and Methods: Patients with TAAAs or pararenal aortic aneurysms who had more than 4 TVs due to renovisceral arterial anatomical variations of renal, celiac, and/or superior mesenteric arteries and received F/B-EVAR between January 2017 and September 2019 at a single aortic center were included in this study. We analyzed technical success, feasibility, and early outcomes. Results: Twelve patients (mean age 70±10 years, 9 males) were included. The anatomical variations included 6 right accessory renal arteries, 8 left accessory renal arteries, and 1 celiac artery variant. Stent-grafts were fenestrated, branched or combined in 6, 5, or 1 patients, respectively. The mean operating time was 346±120 minutes, the mean fluoroscopy time was 80±29 minutes, and the mean radiation dose area product was 430±219 Gy·cm2. The mean contrast volume was 129±45 mL. The total number of TVs was 64; 5 TVs in 9 patients, 6 in 2 patients, and 7 in 1 patient. Technical success was achieved in all cases. The mean intensive care unit stay was 6±5 days, and the mean total hospital stay was 14±10 days. One patient died early (30-day). Early morbidities included respiratory complication in 1 patient, renal insufficiency in 1 patient, and wound infection in 2 patients. No spinal cord ischemia, stroke, or bowel ischemia occurred. Early computed tomography angiography showed 100% patency of the bridging covered stents and TVs. The mean follow-up was 13±4.3 months. No mortality or adverse major event occurred during the follow-up. Two patients with developed type Ic endoleak related to 1 right renal artery and 1 celiac artery covered stent. Patency of the TVs during follow-up was 100%. Conclusion: The use of F/B-EVAR for the treatment of TAAA with more than 4 TVs due to renovisceral arterial anatomical variations in our own experience is feasible and not related to increased morbidity and mortality.

scholarly journals Early and Mid-Term Outcomes of Open Repair, Fenestrated Stent Graft and Chimney Graft in Juxtarenal Abdominal Aortic Aneurysms

2019 ◽  
Vol 58 (6) ◽  
pp. e204-e205
Author(s):  
Khamin Chinsakchai ◽  
Tossapol Prapassaro ◽  
Nicole Rich ◽  
Worawong Slisatkorn ◽  
Kiattisak Hongku ◽  
...  
Keyword(s):  
Stent Graft ◽  
Open Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Fenestrated Stent Graft ◽  
Chimney Graft

Endovascular infrarenal aneurysm repair in patients with horseshoe kidneys: case series and literature review

Vascular ◽  
2011 ◽  
Vol 19 (3) ◽  
pp. 126-131 ◽  
Author(s):  
Y C Chan ◽  
K X Qing ◽  
A C Ting ◽  
S W Cheng
Keyword(s):  
Renal Impairment ◽  
Endovascular Aneurysm Repair ◽  
Case Series ◽  
Horseshoe Kidney ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Long Run ◽  
Co Morbidity ◽  
Aneurysm Repair ◽  
Accessory Renal Arteries

Horseshoe kidney may cause technical and access problems during open aortic aneurysm repair. The aim of this study is to report two cases from our institution and to review the world's literature on successful endovascular infrarenal aneurysm repair in patients with horseshoe kidneys. A retrospective review of a prospectively entered departmental computerized database was performed for the two patients from our institution. Articles were searched electronically from PubMed and Medline, using the terms ‘horseshoe kidney’ and ‘aneurysm’. Endovascular cases were reviewed from the world's literature. In addition to the two patients from our institution, there were 19 patients with infrarenal aneurysms and horseshoe kidneys in published literature who underwent successful endovascular aneurysm repair. The occlusion of lower-pole or accessory renal arteries does not seem to cause significant endoleak or renal impairment in the long run. In conclusion, our experience and current literature seem to suggest that endovascular repair of infrarenal aortic aneurysms for patients with horseshoe kidneys is safe. Renal impairment will depend on the area of kidney perfused by the accessory renal arteries. The endovascular treatment option is less invasive than open repair, and circumvents the problem of difficult exposure, especially in those patients with significant co-morbidity.

scholarly journals In-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
V Makaloski ◽  
D Broger ◽  
S Weiss ◽  
S Jungi ◽  
D Becker ◽  
...  
Keyword(s):  
Stent Graft ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Mesenteric Arteries ◽  
Hospital Death ◽  
Stent Grafts ◽  
Term Outcome ◽  
Aortic Repair

Abstract Objective The aim of the study is to evaluate in-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts (fEVAR / bEVAR). Methods This is a single-center retrospective analysis from a prospectively collected database of all patients treated electively with fEVAR or bEVAR for para/suprarenal (PAA) and thoraco-abdominal aortic aneurysm (TAAA) between September 2010 and June 2019. In-hospital and mid-term mortality, major adverse events and re-interventions were assessed. Results Fifty-one patient (84% male) with a mean age of 74±7 years were analysed. Eighteen patients (35%) had TAAA, four patients (8%) suprarenal, and 29 patients (57%) pararenal aortic aneurysms. Mean aneurysm diameter was 64±8 mm. Thirty-eight patients (75%) underwent fEVAR and 13 patients (25%) bEVAR. A total of 157 target vessels were incorporated: 22 celiac trunks (CT), 40 superior mesenteric arteries (SMA), 92 renal arteries (RA), two separate hepatic arteries and one splenic artery. No in-hospital death or stroke was recorded. One patient suffered from early postoperative paraplegia and did not recover and one had paraparesis after 38 days and recovered completely. Six patients (12%) with patent renal arteries experienced acute postoperative kidney injury; one required temporary dialysis. Five in-hospital re-interventions were stent-graft related (four bridging stents angioplasty and one iliac leg extension) and seven re-interventions were not stent-graft related. Mean follow-up was 19±17 months. Eleven patients (22%) died during follow-up: nine were not aortic-related and two were unknown. The Kaplan-Meier estimated survival rates at 1 and 2 years were 81% and 77%, respectively. Five renal stents (5%, 5/92) occluded during follow-up: three were successfully recanalized and two remained occluded. Ten stents (three CT, five SMA, and two RA stents required relining after 13±16 months postoperatively, resulting with estimated primary assisted patency at 2 years of 100%, 100%, 93%, and 95% for the CT, SMA, right RA and left RA, respectively. Conclusion Complex endovascular aortic repair with fEVAR / bEVAR for PAA and TAAA is safe with very low early mortality and morbidity. In-stent stenosis/occlusions occurred within the first two years. However, primary assisted patency was high. A surveillance program to detect potential stent-graft related complications is mandatory.

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