Abstract:Accessory renal arteries are common and may contribute significantly to renal perfusion. With the current endovascular design and technology, it is possible to preserve accessory renal arteries during endovascular aneurysm repair (EVAR). We report two patients with custom-made EVAR devices to preserve accessory renal arteries with good mid- and long-term clinical and radiological results. Conventional EVAR would have occluded their origins. As a result of customized fenestrations in commercially available sten… Show more
“…Chimney grafts as well as commercially or homemade fenestrated endografts have been designed and used in this setting. 6,8 –10 Based on ARA configuration, patients’ clinical and anatomic characteristics, as well as technical considerations, we propose a treatment algorithm that may help surgeons to choose the most appropriate approach to treat AAA with ARA arising from the aneurysmal sac or neck (Figure 2). Figure 2. Proposed treatment algorithm of abdominal aortic aneurysm with accessory renal arteries arising from the aneurysmal sac or neck.…”
Section: Discussionmentioning
confidence: 99%
“…5 Several endovascular procedures have been developed and can be proposed to spare the ARA, including the use of fenestrated or chimney endografts. 6 –10 However, there is currently only low-quality evidence to support the strategy to cover or to preserve the ARA and the choice relies on the balance between risks and benefits for the patients. 5 A better understanding of the impact of ARA coverage on postoperative outcome may help surgeons to choose the most appropriate approach and minimize postoperative complications.…”
An accessory renal artery (ARA) represents an anatomic variation which can challenge endovascular aortic aneurysm repair (EVAR). The aim of this review was to summarize the current knowledge on postoperative outcomes following ARA coverage during EVAR. We performed a systematic literature review. The MEDLINE database was searched on September 2017, and 8 relevant studies were included. The frequency of ARA in patients undergoing EVAR varied between 9.5% and 16.2%, and the frequency of ARA coverage varied between 5.2% and 9.4%. Four reports did not observe any significant changes on postoperative renal function, whereas 1 study reported an early transient increase in creatinine after ARA coverage. The occurrence of renal infarct varied from 20% to 84%. Five studies did not observe endoleaks related to ARA coverage, whereas one reported the occurrence of type II endoleaks in 3 of 18 patients who had ARA coverage. No significant change in blood pressure, mortality, and mean length of hospital stay was observed. The ARA coverage can potentially have renal and vascular consequences, but none of them were critical. Further studies may be useful to identify preoperative criteria that may help to choose the most appropriate surgical approach before ARA coverage.
“…Chimney grafts as well as commercially or homemade fenestrated endografts have been designed and used in this setting. 6,8 –10 Based on ARA configuration, patients’ clinical and anatomic characteristics, as well as technical considerations, we propose a treatment algorithm that may help surgeons to choose the most appropriate approach to treat AAA with ARA arising from the aneurysmal sac or neck (Figure 2). Figure 2. Proposed treatment algorithm of abdominal aortic aneurysm with accessory renal arteries arising from the aneurysmal sac or neck.…”
Section: Discussionmentioning
confidence: 99%
“…5 Several endovascular procedures have been developed and can be proposed to spare the ARA, including the use of fenestrated or chimney endografts. 6 –10 However, there is currently only low-quality evidence to support the strategy to cover or to preserve the ARA and the choice relies on the balance between risks and benefits for the patients. 5 A better understanding of the impact of ARA coverage on postoperative outcome may help surgeons to choose the most appropriate approach and minimize postoperative complications.…”
An accessory renal artery (ARA) represents an anatomic variation which can challenge endovascular aortic aneurysm repair (EVAR). The aim of this review was to summarize the current knowledge on postoperative outcomes following ARA coverage during EVAR. We performed a systematic literature review. The MEDLINE database was searched on September 2017, and 8 relevant studies were included. The frequency of ARA in patients undergoing EVAR varied between 9.5% and 16.2%, and the frequency of ARA coverage varied between 5.2% and 9.4%. Four reports did not observe any significant changes on postoperative renal function, whereas 1 study reported an early transient increase in creatinine after ARA coverage. The occurrence of renal infarct varied from 20% to 84%. Five studies did not observe endoleaks related to ARA coverage, whereas one reported the occurrence of type II endoleaks in 3 of 18 patients who had ARA coverage. No significant change in blood pressure, mortality, and mean length of hospital stay was observed. The ARA coverage can potentially have renal and vascular consequences, but none of them were critical. Further studies may be useful to identify preoperative criteria that may help to choose the most appropriate surgical approach before ARA coverage.
“…In comparison to a standard implant, a custom-made one is more likely to yield superior functional and esthetic outcomes (148, 149). Typical 3D printing materials can be sterilized using chemicals, such as Food and Drug Administration approved glutaraldehyde protocols (71), steam (20), and gas (150) for intraoperative handling.…”
Section: D Printing In Plastic and Reconstructive Surgerymentioning
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
“…Preservation of flow in relevant ARAs during EVAR is in agreement with the statement of the National Kidney Foundation, which defined CKD on the basis of established kidney damage caused by ischemia/infarction of the parenchyma independent of the changes in creatinine or GFR values. 5 Recently, Chan et al 7 reported on the use of custom-made fenestrated stent-grafts in 2 cases to preserve ARAs during EVAR. However, fenestrated technology requires advanced endovascular skills, complex sizing, and is not widely available.…”
Section: Discussionmentioning
confidence: 99%
“…Consequently, individuals with coverage of clinically relevant ARAs as defined above should be considered CKD patients, independent on the changes in serum creatinine or GFR values. 5 The current literature provides scant information, mainly case reports, 6,7 about endovascular techniques to preserve the flow to relevant ARAs during EVAR. The article presents a series of AAA patients with coexistent relevant ARAs that were treated by standard EVAR and placement of covered stents in the ARAs.…”
In AAA patients unfit for surgical revascularization, EVAR is associated with a significant decline in renal function. For this reason, preservation of relevant coexistent ARAs using the chimney technique should be considered as an option.
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