Endovascular aneurysm repair alters renal artery movement: a preliminary evaluation using dynamic CTA.
OBJECTIVE
To observe the natural renal artery motion during cardiac cycles in patients with abdominal aortic aneurysm (AAA) and how the implantation of stent-grafts may distort this movement.


METHODS
Data on 29 renal arteries from 15 male patients (mean age 72.6 years, range 66-83) treated with Talent or Excluder stent-grafts were acquired using an electrocardiographically (ECG)-gated dynamic 64-slice CT scanner. ECG-triggered retrospective reconstructions were made at 8 equidistant time points over the R-R cardiac cycle. The gated datasets were reconstructed perpendicular to the center flow lumen of each renal artery at 1.2 and 2.4 cm from the renal ostium. Center of mass displacement was determined per cardiac cycle for pre- and post-EVAR renal arteries and compared.


RESULTS
Normal renal artery motion in AAA patients was impressive, with up to 3-mm movement both near and distant from the aorta (mean 2.0+/-0.6 mm, range 1.1-3.0). EVAR inhibited proximal renal motion, resulting in a 31% decrease in maximal movement (mean 1.4+/-0.7 mm, range 0.7-2.0; p < or = 0.05). Distal renal artery motion was unaffected by EVAR, with motion similar to the pre-EVAR state.


CONCLUSIONS
ECG-gated dynamic CTA is feasible on a 64-slice scanner with a standard radiation dose and can detect potentially serious consequences of EVAR. EVAR alters renal artery motion by limiting proximal motion while leaving distal motion unaffected.
Muhs
Bart E
BE
Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.
Teutelink
Arno
A
Prokop
Matthias
M
Vincken
Koen L
KL
Moll
Frans L
FL
Verhagen
Hence J M
HJ
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004562:Electrocardiography; D006801:Humans; D008297:Male; D011300:Preoperative Care; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*