Spiral CT During Selective Accessory Renal Artery Angiography: Assessment of Vascular Territory Before Aortic Stent-Grafting

Abstract

We evaluated the vascular territory of accessory renal arteries in cases where the vessel might be overlapped by an aortic stent-graft. Spiral CT during selective accessory renal artery angiography was performed in four patients with abdominal aortic aneurysms (including one with a horseshoe kidney). The volume of the vascular territory of each renal artery was measured using a software program provided by the CT unit manufacturer. The supernumerary renal arteries perfused 32%, 37%, 15%, and 16% of the total renal mass, respectively. In two patients, stent-grafts were implanted, which resulted in occlusion of the supernumerary renal artery. The volume of the renal infarction was equal to the volume perfused by the artery as calculated before implantation of the stent-graft. The method proposed is accurate for estimating the size of the expected renal infarction. It might help to determine whether placement of a stent-graft is acceptable.

Suprarenal Fixation of Endograft in Abdominal Aortic Aneurysm Treatment

“…34 The results of our series on renal function are comparable to those reported by the above mentioned studies: 2 (4.2%) cases of permanent impairment of global renal function in patients with preoperative RI and no worsening of global renal function was observed in patients with preoperative normal function. These data are also comparable to those reported by Walker and colleagues 37 in which the incidence of renal impairment was of 6.2% after infrarenal aortic stent-graft implantation performed in 164 patients with normal preoperative renal function.…”

“…Current recommendations regarding aberrant renal artery exclusion argue against covering these arteries to preserve renal artery perfusion and prevent adverse consequences. [32][33][34] We were reluctant to cover any vessel that appeared to perfuse more 25% of the kidney parenchyma. Although current imaging modalities have the ability to delineate most of the vascular renal anomalies encountered during evaluation for endograft repair, they cannot provide a quantitative measurement of the area perfused by the artery.…”

“…One method involves nuclear imaging with radionuclide renography, which provides assessment of differential perfusion of the kidneys before the artery in question is killed. The other method was recently reported by Dorffner et al, 34 who uniquely combined selective renal angiography and spiral CT to calculate the volume of renal parenchyma perfused by each artery using a software program provided by the CT manufacturer. Kaplan et al 35 speculate that the low incidence of infarction may be related to poorly understood collateral vascular supply via the renal capsule.…”

“…1-7 Nevertheless, a remarkable rate of patients (30 -40%) are not eligible for endovascular repair because of problems caused by the morphology of the proximal neck. 34 It's well established, in fact, that the proximal infrarenal neck morphology must have precise characteristics to be suitable to endovascular fixation: it has to be a thrombus or plaque-free segment of the aorta of at least 15 mm of length, the angle between the flow axis of the neck and the body of the aneurysm has to be Ͼ120°, and it must not have a pyramidal shape. According to many authors, infrarenal endografting is contraindicated in patients without this neck morphology for the high incidence of type I endoleak or device migration.…”

Tratamento endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso

“…This latter approach has the advantage of being faster and less aggressive 14,15 . The first reports of endovascular treatment of AAAs in patients with horseshoe kidneys date back to 1997, either alone or combined with the occlusion of smaller-caliper accessory renal arteries 2,[16][17][18][19][20][21] . Some studies have assessed the clinical and laboratory results of the occlusion of accessory renal arteries in patients subjected to endovascular treatment of AAAs.…”