Endovascular aneurysm repair with aorto-uni-iliac device: Review of indications and outcomes with a case report of the deployment in a low-lying dominant accessory renal artery

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.

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Renal Artery Coverage During Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.05.005 ◽

2020 ◽

Vol 62 ◽

pp. 63-69 ◽

Cited By ~ 1

Author(s):

Adam Tanious ◽

Laura T. Boitano ◽

Linda J. Wang ◽

Murray L. Shames ◽

Jason T. Lee ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Renal Artery ◽

Endovascular Aneurysm Repair ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Aneurysm Repair

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Dysphagia due to thoracic aortic aneurysm, relieved by thoracic endovascular aneurysm repair: a case report and review of the literature

BMJ Case Reports ◽

10.1136/bcr.09.2011.4793 ◽

2011 ◽

Vol 2011 (nov28 1) ◽

pp. bcr0920114793-bcr0920114793 ◽

Cited By ~ 7

Author(s):

J. Siddiqui ◽

F. Hughes

Keyword(s):

Case Report ◽

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Review Of The Literature ◽

Thoracic Endovascular Aneurysm Repair ◽

Aneurysm Repair

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Impact of renal arterial morphology on fluoroscopy time in chimney endovascular aneurysm repair

Vascular ◽

10.1177/1708538117700765 ◽

2017 ◽

Vol 25 (5) ◽

pp. 514-519 ◽

Cited By ~ 2

Author(s):

Masayuki Sugimoto ◽

Giovanni Torsello ◽

Konstantinos P Donas

Keyword(s):

Renal Artery ◽

Endovascular Aneurysm Repair ◽

Interquartile Range ◽

Fluoroscopy Time ◽

Type Ia ◽

Main Renal Artery ◽

Fluoroscopic Time ◽

Secondary Endpoints ◽

Group A ◽

Aneurysm Repair

Objectives To evaluate the impact of renal artery morphology on fluoroscopy time in chimney endovascular aneurysm repair. Methods Morphology of renal artery was retrospectively quantified in the preoperative CT angiography. Renal artery angulation, ostial diameter, severity of ostial stenosis, main renal artery length, and tortuosity were analyzed with a 3D workstation. The main measure outcome was fluoroscopic time as an indicator of complexity. Uni- and multivariate logistic regression analyses were performed to determine predictors of longer fluoroscopy. Secondary endpoints were amount of contrast medium, patency of renal artery, and type Ia endoleak. Results The enrolled 38 patients (mean age 75.0 years; 34 males) were stratified at the median of fluoroscopic time of 35.2 min (interquartile range, 21.5) and classified in group A ( n = 19) and group B ( n = 19) having a fluoroscopic time of 24.5 (interquartile range, 5.9) and 46.4 (interquartile range, 16.0) min, respectively. The severity of ostial stenosis (OsSte) was significantly different between group A and B of 26.3 ± 13.4% and 41.6 ± 18.0%, respectively; P < .01. ROC curve analysis revealed that 35.5% was an optimal cut-off for OsSte. The difference of renal angulation (RAng) (−22.5° and −2.0°; interquartile ranges 49 and 35; P = .13), and main renal artery length (33.4 ± 11.8 mm and 33.7 ± 14.3 mm; P = .94) were not significantly different. In multivariate analysis after dichotomizing OsSte and RAng, OsSte > 35.5% was identified as the only significant predictor for the longer fluoroscopy (HR: 4.33; 95% CI: 1.02–18.4, P = .04). As for the secondary endpoints, no significant differences were observed between the groups. No correlation between longer fluoroscopy and renal patency or type Ia endoleak was observed. Conclusion Severity of ostial stenosis seems to be a significant predictor for longer fluoroscopic time.

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