Transrenal fixation of aortic stent-grafts for the treatment of infrarenal aortic aneurysmal disease

Abstract

Purpose: We evaluated our early experience with the transrenal fixation of aortic stent-grafts to determine the efficacy of this procedure and its effects on renal artery patency and hemodynamics. Methods: Twenty-eight patients (22 men) had endoluminally placed modular bifurcated stent-grafts with a bare spring structure at the proximal end crossing the origin of both renal arteries; no patient with infrarenal fixation was included for analysis. The mean age of the patients was 75 ± 7 years (range, 58-86 years); the mean aneurysm size was 5.8 ± 0.8 cm (range, 4.7-7.2 cm). Eight patients had preoperative or intraoperative angiographic evidence of renal artery atherosclerotic disease, but only four vessels had luminal narrowing of 50% or greater. No complications were noted during stent-graft placement, and all patients have returned for follow-up visits, ranging from 1 to 12 months (mean follow-up, 6 ± 4 months). Follow-up evaluations included clinical assessment, duplex ultrasound scan of the renal arteries and kidneys, and computed tomographic angiography. Results: No evidence of lobular or sublobular perfusion defects of the renal parenchyma was detected postoperatively. Two patients exhibited postoperative changes in renal artery hemodynamics—one progressing from a 30% diameter reduction to a greater than 60% diameter stenosis at the 12-month follow-up visit and one with a normal renal artery preoperatively having elevated flow velocities indicative of a greater than 60% stenosis at the 1-month visit. Of 19 patients with normal preoperative renal function, only one has had persistently elevated serum creatinine levels. Conclusion: We conclude from this experience that the transrenal placement of open stents is safe and effectively excludes the aneurysm, potentially expanding the availability of this technique to more patients with a short infrarenal aortic neck. Long-term follow-up is essential to determine the overall efficacy of this technique and to identify potential effects on renal artery hemodynamics or kidney function. (J Vasc Surg 2000;32:697-703.)