Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: Assessment of morphological changes by virtual intravascular endoscopy

Zhonghua Sun, Mark E. O'Donnell, John Winder, Peter K. Ellis, Paul H. Blair

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Purpose: To investigate the morphological effects of suprarenal fixation of aortic stent-grafts on the renal artery ostia (RaO) by analysis of suprarenal stent wire distribution and vascular calcification across the RaO using virtual intravascular endoscopy (VIE). Methods: Fourteen consecutive patients (11 men; mean age 75 years) from a single institution were studied following endovascular aortic aneurysm repair (EVAR) using the Zenith endograft system from September 1999 to March 2002. Imaging assessment included computed tomographic (CT) measurement of renal artery intraluminal ostial diameter and quantification and analysis of uncovered stent struts across the RaO and radiological determination of RaO calcification. Morphological changes following EVAR at 3 time points (before and within 1 week after stent-grafting, and at the most recent follow-up) were compared for each patient to determine whether suprarenal stent struts or RaO calcification affected intraluminal ostial diameter. Renal function was assessed by temporal measurements of serum creatinine concentration and creatinine clearance. Results: The renal ostium was distorted to variable degrees in all cases at a mean follow-up of 41 +/-6.6 months. An increase in ostial diameter was identified in most patients if the right RaO was calcified when comparing the 1-week postoperative and most recent follow-up CT images (p<0.05). There was no direct relationship between the number of stent struts crossing the RaO and the morphological/dimensional changes (p>0.05). Renal function was not significantly affected. Conclusion: Patients undergoing suprarenal fixation of aortic stent-grafts experienced morphological changes of the RaO to a variable extent at midterm follow-up. Although the presence of stent struts did not significantly affect dimensional changes, we observed that calcification at the renal artery ostium may influence the development of atherosclerotic effects as a direct relationship between the calcification and ostial diameter. Future studies utilizing VIE to determine the long-term safety of this technique in these particular patients requires investigation.
    LanguageEnglish
    Pages650-660
    JournalJournal of Endovascular Therapy
    Volume14
    Issue number5
    Publication statusPublished - Oct 2007

    Fingerprint

    Renal Artery
    Endoscopy
    Stents
    Transplants
    Aortic Aneurysm
    Kidney
    Creatinine
    Vascular Calcification
    Patient Rights
    Safety
    Serum

    Keywords

    • endovascular aneurysm repair
    • abdominal aortic aneurysm
    • renal function
    • morphology
    • calcification
    • virtual intravascular endoscopy

    Cite this

    Sun, Zhonghua ; O'Donnell, Mark E. ; Winder, John ; Ellis, Peter K. ; Blair, Paul H. / Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: Assessment of morphological changes by virtual intravascular endoscopy. In: Journal of Endovascular Therapy. 2007 ; Vol. 14, No. 5. pp. 650-660.
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    title = "Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: Assessment of morphological changes by virtual intravascular endoscopy",
    abstract = "Purpose: To investigate the morphological effects of suprarenal fixation of aortic stent-grafts on the renal artery ostia (RaO) by analysis of suprarenal stent wire distribution and vascular calcification across the RaO using virtual intravascular endoscopy (VIE). Methods: Fourteen consecutive patients (11 men; mean age 75 years) from a single institution were studied following endovascular aortic aneurysm repair (EVAR) using the Zenith endograft system from September 1999 to March 2002. Imaging assessment included computed tomographic (CT) measurement of renal artery intraluminal ostial diameter and quantification and analysis of uncovered stent struts across the RaO and radiological determination of RaO calcification. Morphological changes following EVAR at 3 time points (before and within 1 week after stent-grafting, and at the most recent follow-up) were compared for each patient to determine whether suprarenal stent struts or RaO calcification affected intraluminal ostial diameter. Renal function was assessed by temporal measurements of serum creatinine concentration and creatinine clearance. Results: The renal ostium was distorted to variable degrees in all cases at a mean follow-up of 41 +/-6.6 months. An increase in ostial diameter was identified in most patients if the right RaO was calcified when comparing the 1-week postoperative and most recent follow-up CT images (p<0.05). There was no direct relationship between the number of stent struts crossing the RaO and the morphological/dimensional changes (p>0.05). Renal function was not significantly affected. Conclusion: Patients undergoing suprarenal fixation of aortic stent-grafts experienced morphological changes of the RaO to a variable extent at midterm follow-up. Although the presence of stent struts did not significantly affect dimensional changes, we observed that calcification at the renal artery ostium may influence the development of atherosclerotic effects as a direct relationship between the calcification and ostial diameter. Future studies utilizing VIE to determine the long-term safety of this technique in these particular patients requires investigation.",
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    author = "Zhonghua Sun and O'Donnell, {Mark E.} and John Winder and Ellis, {Peter K.} and Blair, {Paul H.}",
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    Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: Assessment of morphological changes by virtual intravascular endoscopy. / Sun, Zhonghua; O'Donnell, Mark E.; Winder, John; Ellis, Peter K.; Blair, Paul H.

    In: Journal of Endovascular Therapy, Vol. 14, No. 5, 10.2007, p. 650-660.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: Assessment of morphological changes by virtual intravascular endoscopy

    AU - Sun, Zhonghua

    AU - O'Donnell, Mark E.

    AU - Winder, John

    AU - Ellis, Peter K.

    AU - Blair, Paul H.

    PY - 2007/10

    Y1 - 2007/10

    N2 - Purpose: To investigate the morphological effects of suprarenal fixation of aortic stent-grafts on the renal artery ostia (RaO) by analysis of suprarenal stent wire distribution and vascular calcification across the RaO using virtual intravascular endoscopy (VIE). Methods: Fourteen consecutive patients (11 men; mean age 75 years) from a single institution were studied following endovascular aortic aneurysm repair (EVAR) using the Zenith endograft system from September 1999 to March 2002. Imaging assessment included computed tomographic (CT) measurement of renal artery intraluminal ostial diameter and quantification and analysis of uncovered stent struts across the RaO and radiological determination of RaO calcification. Morphological changes following EVAR at 3 time points (before and within 1 week after stent-grafting, and at the most recent follow-up) were compared for each patient to determine whether suprarenal stent struts or RaO calcification affected intraluminal ostial diameter. Renal function was assessed by temporal measurements of serum creatinine concentration and creatinine clearance. Results: The renal ostium was distorted to variable degrees in all cases at a mean follow-up of 41 +/-6.6 months. An increase in ostial diameter was identified in most patients if the right RaO was calcified when comparing the 1-week postoperative and most recent follow-up CT images (p<0.05). There was no direct relationship between the number of stent struts crossing the RaO and the morphological/dimensional changes (p>0.05). Renal function was not significantly affected. Conclusion: Patients undergoing suprarenal fixation of aortic stent-grafts experienced morphological changes of the RaO to a variable extent at midterm follow-up. Although the presence of stent struts did not significantly affect dimensional changes, we observed that calcification at the renal artery ostium may influence the development of atherosclerotic effects as a direct relationship between the calcification and ostial diameter. Future studies utilizing VIE to determine the long-term safety of this technique in these particular patients requires investigation.

    AB - Purpose: To investigate the morphological effects of suprarenal fixation of aortic stent-grafts on the renal artery ostia (RaO) by analysis of suprarenal stent wire distribution and vascular calcification across the RaO using virtual intravascular endoscopy (VIE). Methods: Fourteen consecutive patients (11 men; mean age 75 years) from a single institution were studied following endovascular aortic aneurysm repair (EVAR) using the Zenith endograft system from September 1999 to March 2002. Imaging assessment included computed tomographic (CT) measurement of renal artery intraluminal ostial diameter and quantification and analysis of uncovered stent struts across the RaO and radiological determination of RaO calcification. Morphological changes following EVAR at 3 time points (before and within 1 week after stent-grafting, and at the most recent follow-up) were compared for each patient to determine whether suprarenal stent struts or RaO calcification affected intraluminal ostial diameter. Renal function was assessed by temporal measurements of serum creatinine concentration and creatinine clearance. Results: The renal ostium was distorted to variable degrees in all cases at a mean follow-up of 41 +/-6.6 months. An increase in ostial diameter was identified in most patients if the right RaO was calcified when comparing the 1-week postoperative and most recent follow-up CT images (p<0.05). There was no direct relationship between the number of stent struts crossing the RaO and the morphological/dimensional changes (p>0.05). Renal function was not significantly affected. Conclusion: Patients undergoing suprarenal fixation of aortic stent-grafts experienced morphological changes of the RaO to a variable extent at midterm follow-up. Although the presence of stent struts did not significantly affect dimensional changes, we observed that calcification at the renal artery ostium may influence the development of atherosclerotic effects as a direct relationship between the calcification and ostial diameter. Future studies utilizing VIE to determine the long-term safety of this technique in these particular patients requires investigation.

    KW - endovascular aneurysm repair

    KW - abdominal aortic aneurysm

    KW - renal function

    KW - morphology

    KW - calcification

    KW - virtual intravascular endoscopy

    M3 - Article

    VL - 14

    SP - 650

    EP - 660

    JO - Journal of Endovascular Therapy

    T2 - Journal of Endovascular Therapy

    JF - Journal of Endovascular Therapy

    SN - 1526-6028

    IS - 5

    ER -