Transrenal Fixation of Aortic Endografts: Intermediate Follow-up of a Single-Center Experience

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Abstract
Purpose: To examine the fate of the renal ostia following transrenal fixation of endovascular aortic stent-grafts. Methods: Thirty-five patients (29 men; mean age 75 years) undergoing endovascular repair for abdominal aortic aneurysms (AAAs) had transrenal fixation of the uncovered proximal stent due to a short (<1.5 cm long) or conical neck or a periprocedural endoleak. Eighteen (51%) patients were hypertensive; 7 (20%) had renal artery stenoses (RAS). Outcome measures included blood pressure, serum creatinine, computed tomography, and renal artery duplex scans. Results: Two patients with ≥60% RAS had renal stents placed during the endograft procedure; the other 5 RAS patients were normotensive and their renal lesions were not treated. Overall technical success was 82.9% (29/35). One (2.9%) case was converted due to graft twisting. There were 5 (14.2%) early endoleaks. Transient postoperative creatinine elevations were observed in 5 (14.2%) cases. Over a median 11-month period (range 2–24), no secondary endoleaks or silent renal artery occlusions were seen. One normotensive patient with an untreated ≥60% renal lesion developed hypertension and severe stenosis (99%) at 4 months; stenting through the interstices of the transrenal stent was performed. No disease progression was seen in the other 6 RAS patients. Conclusions: In the intermediate period, transrenal fixation appears to have no adverse effects on renal blood flow. Moreover, in patients with no evidence of renal disease or preoperative RAS <60%, it does not precipitate or cause progression of renal stenosis. However, patients with preoperatively documented RAS ≥60% are a concern and mandate further study.