Outcome of renal stenting for renal artery coverage during endovascular aortic aneurysm repair.
Outcome of renal stenting for renal artery coverage during endovascular aortic aneurysm repair.
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DOI：
10.1016/j.jvs.2008.11.060
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发表时间：
2009-05
影响因子：
4.3
通讯作者：
Chuter, Timothy A. M.
中科院分区：
文献类型：
--
作者：
Hiramoto, Jade S.;Chang, Catherine K.;Reilly, Linda M.;Schneider, Darren B.;Rapp, Joseph H.;Chuter, Timothy A. M.
确定腹主动脉瘤腔内修复术（EVAR）时连续性肾动脉支架植入术覆盖肾动脉的结局。在2000年8月至2008年8月期间，29名患者使用分叉Zenith覆膜支架和同时肾动脉支架植入术进行了择期腹主动脉瘤腔内修复术。腹主动脉瘤腔内修复术期间的肾动脉支架植入术是通过覆膜支架“侵入”肾动脉口（n = 23）或平行于覆膜支架主体放置肾支架（“通气管”，n = 8）进行的。随访包括常规对比增强计算机断层扫描（CT）、多视图腹部X线检查和1、6和12个月时的肌酐测量，此后每年进行一次。29例31支肾动脉支架置入成功。所有计划植入肾动脉支架的患者（n=18）的近端瘤颈长度<15 mm。接受“通气管”技术的患者的平均近端瘤颈长度（6.9 ± 3.1 mm）短于计划覆膜支架侵入的患者（9.9 ± 2.6 mm）。无计划内覆膜支架侵入的患者瘤颈长度<15 mm（平均长度：26.3±10.2 mm）。平均近端瘤颈成角为42.8 ± 24.0 °，组间无差异。1例患者在完成血管造影时出现I型内漏，另外2例患者在首次术后CT扫描时出现I型内漏。术后1个月CT扫描时，所有I型内漏均消退。中位随访12.5个月（范围2天至77.4个月）时，肾动脉支架的一期辅助通畅率为100%。1例患者在9个月时的随访CT扫描中发现肾动脉支架接近闭塞;通过放置额外的支架恢复了通畅性。1例患者因右髂外动脉损伤导致持续性低血压，需要透析，导致术后出血时间延长。基线时的平均肌酐为1.1 ± 0.3 mg/dl，1个月随访时为1.2 ± 0.5 mg/dl，2年随访时为1.2 ± 0.5 mg/dl。无晚期I型内漏（术后> 1个月）或覆膜支架移位病例。在腹主动脉瘤腔内修复术中使用“侵入”和“通气管”技术行辅助肾动脉支架植入术是安全有效的。短期和中期的一期通畅率非常好，但需要仔细随访以确定这些技术的持久性。
To determine the outcome of adjunctive renal artery stenting for renal artery coverage at the time of endovascular abdominal aortic aneurysm repair (EVAR). Between 8/2000 to 8/2008, 29 patients underwent elective EVAR using bifurcated Zenith stent-grafts and simultaneous renal artery stenting. Renal artery stenting during EVAR was performed with endograft “encroachment” on the renal artery ostium (n = 23) or placement of a renal stent parallel to the main body of the endograft (“snorkel”, n = 8). Follow-up included routine contrast-enhanced computed tomography (CT), multi-view abdominal x-rays, and creatinine measurement at 1, 6, and 12 months, and then yearly thereafter. 31 renal arteries were stented successfully in 29 patients. All patients with planned renal artery stent placement (n=18) had a proximal neck length < 15mm. Mean proximal neck length was shorter in patients who underwent the “snorkel” technique (6.9 ± 3.1 mm) compared to those with planned endograft encroachment (9.9 ± 2.6 mm). None of the patients with unplanned endograft encroachment had neck lengths < 15mm (mean length: 26.3±10.2 mm). Mean proximal neck angulation was 42.8 ± 24.0 degrees and did not differ between the groups. One patient had a type I endoleak on completion angiography, and 2 additional patients had a type I endoleak on the first postoperative CT scan. All type I endoleaks resolved by the one-month postoperative CT scan. Primary-assisted patency of renal artery stents was 100% at a median follow-up of 12.5 months (range 2 days to 77.4 months). One patient had near occlusion of a renal artery stent noted on follow-up CT scan at 9 months; patency was restored by placement of an additional stent. One patient required dialysis following sustained hypotension from a right external iliac artery injury which resulted in prolonged post-operative bleeding. Mean creatinine at baseline was 1.1 ± 0.3 mg/dl, 1.2 ± 0.5 mg/dl at 1 month follow-up, and 1.2 ± 0.5 mg/dl at 2 years of follow-up. There were no cases of late type I endoleaks (>one month postoperatively) or stent-graft migration. Adjunctive renal artery stenting during endovascular AAA repair using the “encroachment” and “snorkel” techniques is safe and effective. Short and medium term primary patency rates are excellent, but careful follow-up is needed to determine the durability of these techniques.
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影响因子：
1.5
作者：
Sampaio, SM;Panneton, JM;Gloviczki, P
通讯作者：
Gloviczki, P
DOI：
10.1097/01.rvi.0000142601.10673.00
发表时间：
2004-12-01
影响因子：
2.9
作者：
England, A;Butterfield, JS;Ashleigh, RJ
通讯作者：
Ashleigh, RJ
影响因子：
4.3
作者：
Greenberg, RK;Clair, D;Ouriel, K
通讯作者：
Ouriel, K
影响因子：
2.6
作者：
Coppi, Gioacchino;Silingardi, Roberto;Gennai, Stefano
通讯作者：
Gennai, Stefano
影响因子：
4.3
作者：
Hiramoto, Jade S.;Reilly, Linda M.;Chuter, Timothy A. M.
通讯作者：
Chuter, Timothy A. M.