Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology

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

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    Abstract

    Objective: The effect of suprarenal stent fixation during endovascular aortic aneurysm repair (EVAR) on renal function remains unclear. A unique validated three-dimensional intraluminal imaging technique was used to analyze the effect of suprarenal stent position relative to renal artery orifices. Also analyzed was its medium-term to long-term effects on renal function. Methods. The study cohort comprised 29 of 34 consecutive patients who underwent EVAR with the Zenith endograft system from September 1999 to March 2002 at a single institution. The precise locations of the uncovered suprarenal stent struts were assessed by a virtual endoscopic imaging technique. Anatomic and quantitative categorization of patients was made according to the configuration of uncovered stent struts across the renal artery ostia (RAO). The anatomic subgroups were defined as struts located centrally or peripherally across both RAO. The quantitative subgroups were defined as RAO crossed by multiple struts, a solitary strut, or no struts. The subgroups were compared for their renal function, as assessed by temporal measurements of serum creatinine concentration and creatinine clearance, and renal parenchymal perfusion defects, as assessed using contrast-enhanced computed tomography (CT). Results. Mean follow-up was 52.7 months. Separate subgroup analysis for both anatomic and quantitative configurations did not demonstrate any significant difference in renal function between the different strut permutations (P > .05). Follow-up imaging confirmed one case of renal infarction secondary to an occluded accessory renal artery, although this patient had normal serum creatinine levels. Conclusion: RAO coverage by suprarenal uncovered stents does not appear to have a significant effect on renal function as evaluated by creatinine measurements in patients with normal preoperative renal function.
    LanguageEnglish
    Pages694-700
    JournalJournal of Vascular Surgery
    Volume45
    Issue number4
    DOIs
    Publication statusPublished - Apr 2007

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    Stents
    Renal Artery
    Transplants
    Kidney
    Creatinine
    Aortic Aneurysm
    Three-Dimensional Imaging
    Serum
    Infarction
    Cohort Studies
    Perfusion
    Tomography

    Cite this

    O'Donnell, Mark E. ; Sun, Zhonghua ; Winder, John ; Ellis, Peter K. ; Lau, Louis L. ; Blair, Paul H. / Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology. In: Journal of Vascular Surgery. 2007 ; Vol. 45, No. 4. pp. 694-700.
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    title = "Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology",
    abstract = "Objective: The effect of suprarenal stent fixation during endovascular aortic aneurysm repair (EVAR) on renal function remains unclear. A unique validated three-dimensional intraluminal imaging technique was used to analyze the effect of suprarenal stent position relative to renal artery orifices. Also analyzed was its medium-term to long-term effects on renal function. Methods. The study cohort comprised 29 of 34 consecutive patients who underwent EVAR with the Zenith endograft system from September 1999 to March 2002 at a single institution. The precise locations of the uncovered suprarenal stent struts were assessed by a virtual endoscopic imaging technique. Anatomic and quantitative categorization of patients was made according to the configuration of uncovered stent struts across the renal artery ostia (RAO). The anatomic subgroups were defined as struts located centrally or peripherally across both RAO. The quantitative subgroups were defined as RAO crossed by multiple struts, a solitary strut, or no struts. The subgroups were compared for their renal function, as assessed by temporal measurements of serum creatinine concentration and creatinine clearance, and renal parenchymal perfusion defects, as assessed using contrast-enhanced computed tomography (CT). Results. Mean follow-up was 52.7 months. Separate subgroup analysis for both anatomic and quantitative configurations did not demonstrate any significant difference in renal function between the different strut permutations (P > .05). Follow-up imaging confirmed one case of renal infarction secondary to an occluded accessory renal artery, although this patient had normal serum creatinine levels. Conclusion: RAO coverage by suprarenal uncovered stents does not appear to have a significant effect on renal function as evaluated by creatinine measurements in patients with normal preoperative renal function.",
    author = "O'Donnell, {Mark E.} and Zhonghua Sun and John Winder and Ellis, {Peter K.} and Lau, {Louis L.} and Blair, {Paul H.}",
    note = "6th Meeting of the Society-of-Academic-and-Research-Surgery, Edinburgh, SCOTLAND, JAN 11-13, 2006",
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    Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology. / O'Donnell, Mark E.; Sun, Zhonghua; Winder, John; Ellis, Peter K.; Lau, Louis L.; Blair, Paul H.

    In: Journal of Vascular Surgery, Vol. 45, No. 4, 04.2007, p. 694-700.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Suprarenal fixation of endovascular aortic stent grafts: Assessment of medium-term to long-term renal function by analysis of juxtarenal stent morphology

    AU - O'Donnell, Mark E.

    AU - Sun, Zhonghua

    AU - Winder, John

    AU - Ellis, Peter K.

    AU - Lau, Louis L.

    AU - Blair, Paul H.

    N1 - 6th Meeting of the Society-of-Academic-and-Research-Surgery, Edinburgh, SCOTLAND, JAN 11-13, 2006

    PY - 2007/4

    Y1 - 2007/4

    N2 - Objective: The effect of suprarenal stent fixation during endovascular aortic aneurysm repair (EVAR) on renal function remains unclear. A unique validated three-dimensional intraluminal imaging technique was used to analyze the effect of suprarenal stent position relative to renal artery orifices. Also analyzed was its medium-term to long-term effects on renal function. Methods. The study cohort comprised 29 of 34 consecutive patients who underwent EVAR with the Zenith endograft system from September 1999 to March 2002 at a single institution. The precise locations of the uncovered suprarenal stent struts were assessed by a virtual endoscopic imaging technique. Anatomic and quantitative categorization of patients was made according to the configuration of uncovered stent struts across the renal artery ostia (RAO). The anatomic subgroups were defined as struts located centrally or peripherally across both RAO. The quantitative subgroups were defined as RAO crossed by multiple struts, a solitary strut, or no struts. The subgroups were compared for their renal function, as assessed by temporal measurements of serum creatinine concentration and creatinine clearance, and renal parenchymal perfusion defects, as assessed using contrast-enhanced computed tomography (CT). Results. Mean follow-up was 52.7 months. Separate subgroup analysis for both anatomic and quantitative configurations did not demonstrate any significant difference in renal function between the different strut permutations (P > .05). Follow-up imaging confirmed one case of renal infarction secondary to an occluded accessory renal artery, although this patient had normal serum creatinine levels. Conclusion: RAO coverage by suprarenal uncovered stents does not appear to have a significant effect on renal function as evaluated by creatinine measurements in patients with normal preoperative renal function.

    AB - Objective: The effect of suprarenal stent fixation during endovascular aortic aneurysm repair (EVAR) on renal function remains unclear. A unique validated three-dimensional intraluminal imaging technique was used to analyze the effect of suprarenal stent position relative to renal artery orifices. Also analyzed was its medium-term to long-term effects on renal function. Methods. The study cohort comprised 29 of 34 consecutive patients who underwent EVAR with the Zenith endograft system from September 1999 to March 2002 at a single institution. The precise locations of the uncovered suprarenal stent struts were assessed by a virtual endoscopic imaging technique. Anatomic and quantitative categorization of patients was made according to the configuration of uncovered stent struts across the renal artery ostia (RAO). The anatomic subgroups were defined as struts located centrally or peripherally across both RAO. The quantitative subgroups were defined as RAO crossed by multiple struts, a solitary strut, or no struts. The subgroups were compared for their renal function, as assessed by temporal measurements of serum creatinine concentration and creatinine clearance, and renal parenchymal perfusion defects, as assessed using contrast-enhanced computed tomography (CT). Results. Mean follow-up was 52.7 months. Separate subgroup analysis for both anatomic and quantitative configurations did not demonstrate any significant difference in renal function between the different strut permutations (P > .05). Follow-up imaging confirmed one case of renal infarction secondary to an occluded accessory renal artery, although this patient had normal serum creatinine levels. Conclusion: RAO coverage by suprarenal uncovered stents does not appear to have a significant effect on renal function as evaluated by creatinine measurements in patients with normal preoperative renal function.

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    EP - 700

    JO - Journal of Vascular Surgery

    T2 - Journal of Vascular Surgery

    JF - Journal of Vascular Surgery

    SN - 0741-5214

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    ER -