Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching

Heidemann, Franziska; Kölbel, Tilo; Debus, Eike Sebastian; Diener, Holger; Carpenter, Sebastian; Rohlffs, Fiona; Tsilimparis, Nikolaos

doi:10.1177/1526602818783506

Cited by 12 publications

(13 citation statements)

References 27 publications

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“…They found that renal function can be salvaged, even if the revascularization procedure has been delayed. 14 They reported a 100% secondary patency rate found on follow-up CTA, without any cases of permanent dialysis postoperatively. 14 The mean renal ischemic time to revascularization was 24 hours (range, 7-168 hours).…”

Section: Discussionmentioning

confidence: 97%

“…13 Another recent study specifically of RAO found an incidence of 3.3% at 11 months of follow-up. 14 However, although the incidence and magnitude of the complication has been reported with greater frequency, available, highquality data regarding the possible treatment options and outcomes are lacking. At present, only a few case reports and one case series have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…At present, only a few case reports and one case series have been reported. Heidemann et al 14 performed a single-center retrospective analysis of seven patients (nine cases of RAO) who had undergone successful treatment by endovascular recanalization from December 2014 to March 2017. They found that renal function can be salvaged, even if the revascularization procedure has been delayed.…”

Section: Discussionmentioning

confidence: 99%

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Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function

Konstantinou

Kölbel²,

Dias

et al. 2021

Journal of Vascular Surgery

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Background: Acute occlusion of renal bridging stent grafts after fenestrated/branched endovascular aortic repair (F/B-EVAR) is an acknowledged complication with high morbidity that often results in chronic dialysis dependence. The feasibility and effect of timely or late ($6 hours of ischemia) renal artery revascularization has not been adequately reported.Methods: We performed a retrospective, multicenter study across 11 tertiary institutions of all consecutive patients who had undergone revascularization of renal artery stent graft occlusions after complex EVAR. The end points were technical success, association between ischemia time and renal function salvage, interventional complications, mortality, and midterm outcomes.Results: From 2009 to 2019, 38 patients with 46 target vessels (TVs; eight bilateral occlusions) were treated for renal artery occlusions after complex EVAR (mean age, 63.5 6 10 years; 63.2% male). Six patients had a solitary kidney (15.8%). Of the 38 patients, 16 (42.1%) had undergone FEVAR and 22 (57.9%) had undergone BEVAR. The technical success rate was 95.7% (44 of 46 TVs). The recanalization technique used was sole aspiration thrombectomy in 5.3%, aspiration thrombectomy and stent graft relining in 52.6%, and sole stent graft relining in 36.8%. The median renal ischemia time was 27.5 hours (range, 4-720 hours; interquartile range, 4-36 hours). Most patients (94.4%) had been treated after $6 hours of renal ischemia time, and 55.6% had been treated after 24 hours. In 14 patients (36.8%), renal function had improved after intervention (mean glomerular filtration rate improvement, 14.2 6 9 mL/min/1.73 m 2 ). However, 24 patients (63.2%) showed no improvement. Improvement of renal function did not correlate with the length of renal ischemia time. Of the 14 patients with bilateral renal artery occlusion or a solitary kidney, 9 experienced partial recovery of renal function and no longer required hemodialysis. In-hospital mortality was 2.6%. The cause of renal stent graft occlusion could not be identified in 50% of the TVs (23 of 46). However, in 19 (41.3%), significant stenosis or a kink of the renal stent graft was found. The median follow-up was 11 months (interquartile range, 0-28 months). The estimated 1-year patient survival and patency rate of the renal stent grafts was 97.4% and 83.8%, respectively.Conclusions: Revascularization of occluded renal bridging stent grafts after F/B-EVAR is a safe and feasible technique and can lead to significant improvement of renal function, even after long ischemia times (>24 hours) of the renal parenchyma or bilateral occlusion, as long as residual perfusion of the renal parenchyma has been preserved. Also, the longterm patency rates justify aggressive management of renal artery occlusion after F/B-EVAR.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function

Konstantinou

Kölbel²,

Dias

et al. 2021

Journal of Vascular Surgery

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“…Heideman et al describe the potential renal collateral network and cases with reestablishing renal function after endovascular salvage in patients with renal ischemia > 6 hours, (ranging from 7 to 168 hours). 14 The potential collateral renal network includes the lumbar and intercostal arteries that can salvage partial and complete kidney function in a case of acute renal artery occlusion. 15 The present case supports the theory of a collateral network and the possibility to preserve renal function and avoid permanent dialysis even after extensive renal ischemia time.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular intervention such as thrombolysis after renal stent-graft occlusion is often used and can be helpful to remove thrombus and avoid the distal peripheral small renal emboli and additional kidney damage. 14 Patients with rapid renal deterioration can be treated with endovascular thrombectomy (e.g Angiojet, Boston Scientific, USA) and immediate flow restoration followed by thrombolysis to avoid further ischemic renal damage. 14 Open surgical repair with aorto/visceral-renal or iliac-renal bypass is possible, but in most cases, endovascular treatment should be considered the primary option if available.…”

Section: Discussionmentioning

confidence: 99%

T Branch Repair of Ruptured a Type IV Thoracoabdominal Aortic Aneurysm Complicated by Renal Branch Occlusion

Duvnjak

Bach-Frommer

Resch

2021

Vasc Endovascular Surg

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A 60-year male patient presented with a thoracoabdominal aortic aneurysm rupture, which was treated emergently with a modified off-the-shelf t-Branch stent-graft (COOK Medical Inc). The sole renal branch occluded 1 month after TEVAR due to branch compression, and the patient became anuric and temporarily dialysis-dependent. Despite the prolonged renal ischemia time, the occluded renal branch was successfully opened with thrombolysis and reinforced with a bare-metal stent. The patient recovered his renal function and came off dialysis.

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Successful endovascular treatment of chronic renal artery occlusion: a preliminary retrospective case series including 15 patients

et al. 2019

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Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching

Cited by 12 publications

References 27 publications

Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function

Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function

T Branch Repair of Ruptured a Type IV Thoracoabdominal Aortic Aneurysm Complicated by Renal Branch Occlusion

Successful endovascular treatment of chronic renal artery occlusion: a preliminary retrospective case series including 15 patients

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