Pressure gradient measurement to verify hemodynamic results of the chimney endovascular aortic repair (chEVAR) technique

Purpose The use of the pressure gradient measurements to assess the renal artery flow hemodynamics after chimney endovascular aortic repair (chEVAR). Methods The study was a prospective analysis of 37 chEVAR procedures performend in 24 patients with perirenal aortic aneurysm. In all patients the measurement of: distal renal artery pressure (Pd), aortic pressure (Pa), Pd/Pa ratio (Pd/Pa) and mean gradient (MG) between the aorta and the distal renal artery were performed. Measurements were taken with 0.014 inch pressure wire catheter before and after the chEVAR procedure. MG greater than 9 mmHg and Pd/Pa ratio below 0.90 were considered as the measures of a significant decrease in distal pressure that limited flow in renal arteries. The 6 month follow-up computed tomographic angiography (CTA) was performed in all patients to diagnose potential endoleak presence and to verify the patency of the chimney stent-grafts. Results All procedures were successful, and no periprocedural complications were observed in any of the patients. The mean gradient values before and after the chimney implantation did not change significantly (6,2±2,0 mmHg and 6,8±2,2 mmHg, respectively). Similarly, no significant change in Pd/Pa values was noted with the value of 0.9 observed both before and after the procedure. All chimney stents were patent on the control CTA. Type Ia endoleak was found in 4 (10.8%) patients. Conclusions The application of the described technique seems to be a safe method which allows a direct measurement of renal artery flow hemodynamics before and after chimney implantation during the chEVAR technique. The use of covered balloon expandable stents, ensures the proper blood flow in the renal arteries during the chEVAR technique.

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Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211012403 ◽

2021 ◽

pp. 152660282110124

Author(s):

Luca Mezzetto ◽

Davide Mastrorilli ◽

Nicola Leone ◽

Stefano Gennai ◽

Roberto Silingardi ◽

...

Keyword(s):

Renal Artery ◽

Endovascular Aneurysm Repair ◽

Renal Arteries ◽

Endovascular Aortic Repair ◽

Type I ◽

Target Vessel ◽

Technical Success ◽

Transverse Axis ◽

Aortic Repair

Purpose: To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). Materials and Methods: Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle <30° associated with a renal artery angulation >90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. Results: A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. Conclusion: The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.

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Comparison of Fluid Dynamics Variations Between Chimney and Fenestrated Endografts for Pararenal Aneurysms Repair: A Patient Specific Computational Study as Motivation for Clinical Decision-Making

Vascular and Endovascular Surgery ◽

10.1177/1538574419867531 ◽

2019 ◽

Vol 53 (7) ◽

pp. 572-582 ◽

Cited By ~ 1

Author(s):

Konstantinos G. Moulakakis ◽

John Kakisis ◽

Eleni Gonidaki ◽

Andreas M. Lazaris ◽

Sokrates Tsangaris ◽

...

Keyword(s):

Endovascular Repair ◽

Clinical Decision Making ◽

Computational Study ◽

Fluid Dynamic ◽

Renal Arteries ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Patient Specific ◽

Aortic Repair ◽

Before And After

Background-Aim: Limited data exist concerning the fluid dynamic changes induced by endovascular aortic repair with fenestrated and chimney graft modalities in pararenal aneurysms. We aimed to investigate and compare the wall shear stress (WSS) and flow dynamics for the branch vessels before and after endovascular aortic repair with fenestrated and chimney techniques. Methods: Modeling was done for patient specific pararenal aortic aneurysms employing fenestrated and chimney grafts (Materialise Mimics 10.0) before and after the endovascular procedure, using computed tomography scans of patients. Surface and spatial grids were created using the ANSYS CFD meshing software 2019 R2. Assessment of blood flow, streamlines, and WSS before and after aneurysm repair was performed. Results: The endovascular repair with chimney grafts leaded to a 43% to 53% reduction in perfusion in renal arteries. In fenestrated reconstruction, we observed a 15% reduced perfusion in both renal arteries. In both cases, we observed a decrease in the recirculation phenomena of the aorta after endovascular repair. Concerning the grafts of the renal arteries, we observed in both the transverse and longitudinal axes low WSS regions with simultaneous recirculation of the flow 1 cm distal to the ostium sites in both aortic graft models. High WSS regions appeared in the sites of ostium. Conclusions: We observed reduced renal perfusion in chimney grafts compared to fenestrated grafts, probably caused by the long and kinked characteristics of these devices.

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Abstract No. 116: MultiDetector Computed Tomographic Angiography of the Renal Arteries for the Diagnosis of Atherosclerotic Renal Artery Stenosis: Comparison with Digital Subtraction Angiography

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.12.098 ◽

2009 ◽

Vol 20 (2) ◽

pp. S46

Author(s):

S.S. Shah ◽

R.A. Lookstein ◽

E. Lehrman ◽

J.L. Weintraub ◽

P.A. Stangl ◽

...

Keyword(s):

Renal Artery ◽

Digital Subtraction Angiography ◽

Renal Artery Stenosis ◽

Computed Tomographic Angiography ◽

Renal Arteries ◽

Artery Stenosis ◽

Digital Subtraction ◽

Atherosclerotic Renal Artery Stenosis ◽

Computed Tomographic ◽

Tomographic Angiography

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A Novel Reverse Branch Technique for Reconstruction of a Renal Artery Perfused by the False Lumen After Thoracic Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/1526602817725265 ◽

2017 ◽

Vol 24 (6) ◽

pp. 814-818 ◽

Cited By ~ 2

Author(s):

Jie Jin ◽

Jun Bai ◽

Yongfa Wu ◽

Kangkang Zhi ◽

Xiaomin Wang ◽

...

Keyword(s):

Renal Artery ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Aortic Repair ◽

Reverse Branch

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PRIMARY ALDOSTERONISM: THE RESULTS OF THE TREATMENT ACCORDING TO THE DATA OF RENAL ARTERIES DUPLEX SCANNING

World Science ◽

10.31435/rsglobal_ws/30042019/6471 ◽

2019 ◽

Vol 2 (4(44)) ◽

pp. 16-21

Author(s):

Zubryk I. V.

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Renal Artery ◽

Primary Aldosteronism ◽

Reference Range ◽

Renal Arteries ◽

Duplex Scanning ◽

Aldosterone Level ◽

Before And After ◽

Segmental Arteries

In the structure of arterial hypertension, primary aldosteronism (РА) ranges from 5 to 15%. Changes in intrarenal hemodynamics are due to both high blood pressure and direct aldosterone level. The purpose of the study was to analyze the results of PA treatment according to ultrasound doppler scanning of renal arteries. In general, 55 patients with PA were treated. Renal arteries duplex scanning before and after the treatment was performed in 20 patients. During treatment, the normalization of Vps, Ved, S/D, PI, PI, AT, TAMX indices was recorded in patients. The RI of the interlobar arteries slightly increased, however, it remained within the reference range. The reduction of aldosterone levels led to increase of TAMX index at the level of the renal artery trunk, S/D, RI and decrease in AT at the level of the segmental arteries, as well as increase of Ved and S/D at the level of the interlobar arteries.

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Psoas Cross-sectional Measurements Using Manual CT Segmentation Before and After Endovascular Aortic Repair (EVAR)

10.26226/morressier.60e81cc65d86378f03b4193c ◽

2021 ◽

Author(s):

Francesco Secchi

Keyword(s):

Endovascular Aortic Repair ◽

Cross Sectional ◽

Aortic Repair ◽

Before And After ◽

Ct Segmentation

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Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

SAGE Open Medical Case Reports ◽

10.1177/2050313x20953011 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2095301

Author(s):

Emanuele Gatta ◽

Gabriele Pagliariccio ◽

Sara Schiavon ◽

Carlo Grilli Cicilioni ◽

Luciano Carbonari

Keyword(s):

Open Repair ◽

Endovascular Aortic Repair ◽

Late Type ◽

Stent Grafts ◽

Computed Tomographic ◽

Chimney Technique ◽

Aortic Repair ◽

Computed Tomographic Scan ◽

Type Ia ◽

Long Time

The late type Ia endoleak after endovascular aortic repair could be a challenging issue. Over the last years, in case of short or enlarged neck, fenestrated and branched stent grafts have been increasingly employed with improving results. However, these devices have limited use in urgent/emergent cases as custom graft manufacturing takes long time, and may not be fit in patients with particular anatomic features. In this setting, chimney and relining remain an alternative but sometimes may not be adequate. According to literature, the use of the endoanchors associated to chimney technique can improve the procedure results in primary endovascular aortic repair. We treated two patients with a late type Ia endoleak after endovascular aortic repair with a simultaneous relining, single renal chimney, and endoanchors implant. These patients were valuated unfit for open repair with neck configuration unadapt for a simple relining, ballooning, or stenting. The patient conditions were unfavorable for an endovascular repair with branched endovascular aortic repair–fenestrated endovascular aortic repair. The same procedure was performed in both patients. Postoperative angio-computed tomographic scan demonstrated the resolution of the endoleak with patency of renal graft. Our preliminary experience, in these selected cases, demonstrate the feasibility of the technique in late type Ia endoleak.

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