title: Renal perfusion defects after endovascular repair of abdominal aortic aneurysms.
abstract: OBJECTIVE
  To determine the prevalence of new renal perfusion defects and the association of these events with aneurysm neck atheroma during endovascular stent-graft repair of abdominal aortic aneurysm (AAA).
  
  
  METHODS
  A retrospective review was performed of 50 patients who underwent AAA repair with bifurcated endovascular stent-grafts without suprarenal components between June 1998 and May 1999. Pre- and postprocedural computed tomographic (CT) angiograms were reviewed to determine the prevalence of new renal perfusion defects. The percent volume of atheroma of the aneurysm neck was determined by three-dimensional volumetric reformation and correlated with prevalence of new postprocedural renal perfusion defects. Follow-up CT angiography was performed between 6 months and 2 years after the procedure and used to evaluate the presence of residual defects and interval changes.
  
  
  RESULTS
  Of 50 subjects, 18% (n = 9) had new perfusion defects presumed to be embolic in origin. Follow-up was available for four patients: scarring and cortical thinning consistent with infarction developed in two, whereas the defects resolved in the other two. Analysis of aneurysm neck revealed an average percentage of atheroma of 32% and a range of 0%-73%. In subjects with >/=40% neck atheroma, the prevalence of new renal perfusion defects was 45.4% (five of 11), compared to 10.3% (four of 39) in subjects with <40% neck atheroma. This difference was significant (P =.0170).
  
  
  CONCLUSIONS
  In this series, the frequency of renal embolic events associated with AAA endovascular repair was 18%. Prevalence of renal embolic perfusion defects was shown to correlate with volume of aneurysm neck atheroma.
authors.affiliation: Department of Vascular Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA. jrharris@partners.org
authors.forename: Jason R
authors.initials: JR
authors.lastname: Harris
authors.forename: Chieh-Min
authors.initials: CM
authors.lastname: Fan
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Geller
authors.forename: David C
authors.initials: DC
authors.lastname: Brewster
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Greenfield
authors.forename: John G
authors.initials: JG
authors.lastname: Santilli
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Waltman
mesh_terms: D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004617:Embolism / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed