Transrenal fixation of aortic endografts: intermediate follow-up of a single-center experience.

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 > or = 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 > or = 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 > or = 60% are a concern and mandate further study.