Abstract
PurposeThe use of the pressure gradient measurements to assess the renal artery flow hemodynamics after chimney endovascular aortic repair (chEVAR).MethodsThe 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.ResultsAll 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.ConclusionsThe 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.
Highlights
The first report on chimney repair technique for abdominal aortic aneurysm (AAA) was published around 2003 when this method has been described in detail by R
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
The chimney repair technique was considered an adjunctive salvage procedure used whenever the entry to renal arteries were unintentionally covered during the endovascular aneurysm repair (EVAR)
Summary
The first report on chimney repair technique for abdominal aortic aneurysm (AAA) was published around 2003 when this method has been described in detail by R. Shortly after that, the chimney/periscope technique, with the deployment of the stents into abdominal aortic branches, has been used as a method to retain flow in the renal arteries in patients with juxtarenal or pararenal aneurysms [1,2,3]. Large studies, involving hundreds of patients, demonstrated that the chimney technique for endovascular aortic repear (chEVAR) was superior to both open surgical technique [4,5,6,7,8,9] and fenestrated endovascular aneurysm repair (fEVAR) [10,11,12]. ChEVAR poses some challenges for the operator including patient qualification [13], selection of an appropriate device, retaining flow in the stented vessels, and management of potential complications, such as endoleak
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