Endovascular repair of abdominal aortic aneurysms in patients with congenital renal vascular anomalies

D. B. Kaplan, C. C. Kwon, M. L. Marin, L. H. Hollier, William Edwards

    Research output: Contribution to journalArticle

    63 Citations (Scopus)

    Abstract

    Purpose: The endovascular repair of abdominal aortic aneurysms (AAAs) has been suggested as an alternative to conventional aortic reconstruction. The presence of anomalous renal vascular anatomy frequently necessitates special planning during conventional aortic replacement and may also create unique challenges for endovascular repair. We analyzed our experience with 24 patients with variant renal vascular anatomies who underwent treatment with aortic endografts to determine the safety and efficacy of this technique in this population. Methods: During a 6-year period, 204 patients underwent aortic endograft procedures, 24 (11.8%) of whom had variations in renal vascular anatomy. There were 19 men and five women. Each of the 24 patients had variant renal vascular anatomy, which was defined by the presence of multiple renal arteries (n = 32), with or without a renal parenchymal anomaly (horseshoe or solitary pelvic kidney). Twenty patients underwent aneurysm repair with balloon expandable polytetrafluoroethylene grafts, and the remaining patients underwent endograft placement with self-expanding attachment systems. Eighteen patients underwent exclusion and presumed thrombosis of anomalous renal branches to effectively attach the aortic endograft. The decision to sacrifice a supernumerary artery was made on the basis of the vessel size (<3 mm), the absence of coexisting renal insufficiency, and the expectation for successful aneurysm exclusion. Results: The successful exclusion of the AAAs was achieved in all the patients, with the loss of a total of 17 renal artery branches in 12 patients. Small segmental renal infarcts (<20%) were detected in only six of the 12 patients with follow-up computed tomographic scan results, despite angiographic evidence of vessel occlusion at the time of endografting. No evidence of new onset hypertension or changes in antihypertensive medication was seen in this group. No retrograde endoleaks were detected through the excluded renal branches on late follow-up computed tomographic scans. Serum creatinine levels before and after endografting were unchanged after the exclusion of the AAA in all but one patient with multiple renal branches. One patient had a transient rise in serum creatinine level presumed to be caused by contrast nephropathy. Conclusion: On the basis of this experience, we recommend the consideration of endovascular grafting for patients with AAAs and anomalous renal vessels when the main renal vascular anatomy can be preserved and when the loss of only small branches (<3 mm) is necessitated in patients with otherwise normal renal functions.

    Original languageEnglish (US)
    Pages (from-to)407-416
    Number of pages10
    JournalJournal of Vascular Surgery
    Volume30
    Issue number3
    DOIs
    StatePublished - Jan 1 1999

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    Abdominal Aortic Aneurysm
    Blood Vessels
    Kidney
    Anatomy
    Renal Artery
    Aneurysm
    Creatinine
    Endoleak
    Polytetrafluoroethylene
    Serum
    Antihypertensive Agents
    Renal Insufficiency
    Thrombosis
    Arteries

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Endovascular repair of abdominal aortic aneurysms in patients with congenital renal vascular anomalies. / Kaplan, D. B.; Kwon, C. C.; Marin, M. L.; Hollier, L. H.; Edwards, William.

    In: Journal of Vascular Surgery, Vol. 30, No. 3, 01.01.1999, p. 407-416.

    Research output: Contribution to journalArticle

    Kaplan, D. B. ; Kwon, C. C. ; Marin, M. L. ; Hollier, L. H. ; Edwards, William. / Endovascular repair of abdominal aortic aneurysms in patients with congenital renal vascular anomalies. In: Journal of Vascular Surgery. 1999 ; Vol. 30, No. 3. pp. 407-416.
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    abstract = "Purpose: The endovascular repair of abdominal aortic aneurysms (AAAs) has been suggested as an alternative to conventional aortic reconstruction. The presence of anomalous renal vascular anatomy frequently necessitates special planning during conventional aortic replacement and may also create unique challenges for endovascular repair. We analyzed our experience with 24 patients with variant renal vascular anatomies who underwent treatment with aortic endografts to determine the safety and efficacy of this technique in this population. Methods: During a 6-year period, 204 patients underwent aortic endograft procedures, 24 (11.8{\%}) of whom had variations in renal vascular anatomy. There were 19 men and five women. Each of the 24 patients had variant renal vascular anatomy, which was defined by the presence of multiple renal arteries (n = 32), with or without a renal parenchymal anomaly (horseshoe or solitary pelvic kidney). Twenty patients underwent aneurysm repair with balloon expandable polytetrafluoroethylene grafts, and the remaining patients underwent endograft placement with self-expanding attachment systems. Eighteen patients underwent exclusion and presumed thrombosis of anomalous renal branches to effectively attach the aortic endograft. The decision to sacrifice a supernumerary artery was made on the basis of the vessel size (<3 mm), the absence of coexisting renal insufficiency, and the expectation for successful aneurysm exclusion. Results: The successful exclusion of the AAAs was achieved in all the patients, with the loss of a total of 17 renal artery branches in 12 patients. Small segmental renal infarcts (<20{\%}) were detected in only six of the 12 patients with follow-up computed tomographic scan results, despite angiographic evidence of vessel occlusion at the time of endografting. No evidence of new onset hypertension or changes in antihypertensive medication was seen in this group. No retrograde endoleaks were detected through the excluded renal branches on late follow-up computed tomographic scans. Serum creatinine levels before and after endografting were unchanged after the exclusion of the AAA in all but one patient with multiple renal branches. One patient had a transient rise in serum creatinine level presumed to be caused by contrast nephropathy. Conclusion: On the basis of this experience, we recommend the consideration of endovascular grafting for patients with AAAs and anomalous renal vessels when the main renal vascular anatomy can be preserved and when the loss of only small branches (<3 mm) is necessitated in patients with otherwise normal renal functions.",
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    AU - Edwards, William

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