Analysis of renal function after aneurysm repair with a device using suprarenal fixation (zenith AAA endovascular graft) in contrast to open surgical.

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Presentation transcript:

Analysis of renal function after aneurysm repair with a device using suprarenal fixation (zenith AAA endovascular graft) in contrast to open surgical repair Roy K. Greenberg, MD, Timothy A.M. Chuter, MD, Michael Lawrence-Brown, MD, Stephan Haulon, MD, Lori Nolte, PhD Journal of Vascular Surgery Volume 39, Issue 6, Pages 1219-1228 (June 2004) DOI: 10.1016/j.jvs.2004.02.033

Fig 2 Mean percent change in predicted (Cockcroft-Gault equation) creatinine clearance for all patients in standard surgical risk (SSR) and Zenith standard risk (ZSR) groups. Note nearly identical change in creatinine clearance between ZSR and SSR groups at 12 months. Trend toward improvement in creatinine clearance from 12 to 24 months did not reach statistical significance (P = .51) Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)

Fig 3 Mean percent change in predicted (Cockcroft-Gault equation) creatinine clearance for patients with greater than 30% rise in serum creatinine concentration from baseline at 12 months. Renal dysfunction was nearly identical between the Zenith standard risk (ZSR) and standard surgical risk (SSR) groups at 12 months. Improvement in creatinine clearance in ZSR group between 12 and 24 months did not reach statistical significance (P = .06), but provides reassurance of renal function stabilization. Graph for each ZSR group patient included in the calculation for this figure is depicted in Fig 4, online only. Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)

Fig 5 Chart of patients (9/351) who underwent endovascular treatment in whom graft material impinged on a renal artery. This figure reinforces the importance of assessing the proximal aspect of the graft material with respect to impingement on the renal ostia. Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)

Fig 7 Access to a secondary renal branch was accomplished via a brachial approach through the suprarenal stent. Note the two 0.014-inch wires, one in each of the primary renal branches. These were used to introduce balloons for balloon dilation of the stenosis with the kissing balloon technique. Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)

Fig 6 Series of images illustrates the case of a patient who underwent endovascular repair with the Zenith device. A, After the initial procedure both renal arteries were patent, although difficult to visualize with a portable imaging unit. B, Three hours after the procedure anuria developed; retrospective assessment of intraoperative images demonstrated partial coverage of the renal ostia. The patient was brought to an interventional suite, where an angiogram was obtained from a brachial approach. The renal arteries demonstrate no flow on this image. C and D, Access to each renal artery was accomplished, and stents were placed within the renal ostia to push the fabric down slightly. E, Final angiogram shows unobstructed renal blood flow bilaterally. The patient had a transient rise in serum creatinine concentration, which was normal at the 30-day follow-up visit. Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)

Fig 6 Series of images illustrates the case of a patient who underwent endovascular repair with the Zenith device. A, After the initial procedure both renal arteries were patent, although difficult to visualize with a portable imaging unit. B, Three hours after the procedure anuria developed; retrospective assessment of intraoperative images demonstrated partial coverage of the renal ostia. The patient was brought to an interventional suite, where an angiogram was obtained from a brachial approach. The renal arteries demonstrate no flow on this image. C and D, Access to each renal artery was accomplished, and stents were placed within the renal ostia to push the fabric down slightly. E, Final angiogram shows unobstructed renal blood flow bilaterally. The patient had a transient rise in serum creatinine concentration, which was normal at the 30-day follow-up visit. Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)

Fig 8 Cobra 2 catheter access to a renal artery can be accomplished before complete deployment of the uncovered suprarenal stent. To achieve this, the top stent is partially deployed, and through the contralateral limb a wire is guided through the struts of the top stent. Journal of Vascular Surgery 2004 39, 1219-1228DOI: (10.1016/j.jvs.2004.02.033)