A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair Rafael D. Malgor, MD, Gustavo S.

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A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair Rafael D. Malgor, MD, Gustavo S. Oderich, MD, Terri J. Vrtiska, MD, Manju Kalra, MBBS, Audra A. Duncan, MD, Peter Gloviczki, MD, Stephen Cha, MS, Thomas C. Bower, MD Journal of Vascular Surgery Volume 58, Issue 6, Pages 1467-1475 (December 2013) DOI: 10.1016/j.jvs.2013.06.068 Copyright © 2013 Terms and Conditions

Fig 1 A, A computed tomography angiography (CTA) of a patient with a 5.8-cm infrarenal abdominal aortic aneurysm (AAA) is depicted showing an area supplied by an accessory renal artery (ARA) with correspondent perfusion defect. B, Three months from endovascular aneurysm repair (EVAR), the same malperfused area related to the occluded ARA remains unchanged in size. C, Preoperative CT scan showing a 6.2-cm aneurysm with well-perfused kidneys. D, At 2-month follow-up, a CTA demonstrated decreased perfusion to both upper poles. The right kidney parenchyma infarcted area is more noticeable than the left. Note that the aneurysm sac has shrunk, and there is no evidence of any endoleak. An exact correlation between ARA and its supplied kidney parenchyma was confirmed by CTA in both cases. Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions

Fig 2 A, Preoperative computed tomography (CT) scan shows a patent accessory renal artery (ARA) supplying the left upper pole of the kidney. B, Two months later, the same area is infarcted; no loss of parenchyma mass. C, After 4 years, the right upper pole parenchymal mass is decreased in size. D, At 7-year follow-up, a CT scan demonstrated a progressive loss of parenchymal mass despite stable estimated glomerular filtration rate (eGFR) since the procedure. Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions

Fig 3 Variation in systemic blood pressure of patients with covered or preserved accessory renal artery (ARA) and with no ARA following endovascular aneurysm repair (EVAR). DBP, Diastolic blood pressure; MAP, mean arterial pressure; SBP, systolic blood pressure. Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions

Fig 4 Postoperative renal function in patients with preserved, covered, and no accessory renal artery (ARA) after endovascular aneurysm repair (EVAR). GFR, Glomerular filtration rate. Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions

Fig 5 Subset analysis of estimated glomerular filtration rate (eGFR) variation in chronic kidney disease (CKD) class III to IV patients who had accessory renal artery (ARA) occlusion or preservation after endovascular aneurysm repair (EVAR) along with those patients with no ARA. Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions

Fig 6 A 76-year-old male who underwent endovascular aneurysm repair (EVAR) for a 5.9-cm infrarenal aortic aneurysm was found to have a 6-mm sac enlargement detected in a 3-month follow-up computed tomography angiography (CTA). A, A type II endoleak caused by a patent accessory renal artery (ARA) and inferior mesenteric artery (IMA) is demonstrated in the three-dimensional reconstruction image. B, Selective catheterization of the ARA via the translumbar approach is carried out with successful coil embolization. C, Subsequently, IMA coil embolization is also performed with resolution of the type II endoleak. Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions

Fig 7 Kaplan-Meier curve depicting 5-year survival free from any endoleak in patients with no accessory renal artery (ARA) who underwent endovascular aneurysm repair (EVAR) and in those with ARA occlusion or preservation (standard error ≥10% starts at the arrows). Journal of Vascular Surgery 2013 58, 1467-1475DOI: (10.1016/j.jvs.2013.06.068) Copyright © 2013 Terms and Conditions