title: Anatomic study of juxta renal aneurysms: impact on fenestrated stent-grafts.
abstract: BACKGROUND
  Fenestrated stent-grafts allow for treatment of patients with juxtarenal aneurysms (JRA) when they present with contraindications for conventional treatment. The fenestrated module is a custom-made module, specially designed to fit a specific patient, using computed tomographic scan measurements, which entails manufacturing delay and high cost. The aim of our study was to evaluate the possibility to reproduce the interrenal aorta anatomy to design a standard fenestrated module that would fit the maximum number of patients with JRA.
  
  
  METHODS
  On a three-dimensional working station, we analyzed 289 preoperative computed tomographic scan results of patients with JRA and who were treated with fenestrated stent-grafts comprising two fenestrations for the renal arteries and a scallop for the superior mesenteric artery (SMA). On curvilinear reconstructions, we successively measured the interrenal aorta diameter, its orientation, as well as the height of each renal ostium, taking the ostium center of the SMA as a reference mark. Later, a statistical analysis of these measures distribution was performed so as to design a fenestrated module that would fit the maximum number of patients.
  
  
  RESULTS
  The center of the left renal artery presented with a median orientation of 82.5° (range, 37.5-150) and a median distance of 9 mm (range, 0-30), in relation to the SMA ostium. The ostium center of the right renal artery presented with a median orientation of 285° (range, 240-337.5) and a median distance of 8 mm (range, 3-30), in relation to the SMA ostium. By positioning the current renal fenestrations (6-mm wide), on the basis of the calculated median positions, in our series, only 20% of the patients could be treated with a standard fenestrated module. Should the diameter of these fenestrations be increased by 10 mm, it would then be possible to treat 50% of our patients.
  
  
  CONCLUSIONS
  The anatomy of the interrenal aorta and its branches is quite reproducible to design standard fenestrated stent-grafts that could treat half of the patients with JRA.
authors.affiliation: Chirurgie Vasculaire, Hôpital Cardiologique, CHRU de Lille, Université Lille, Lille, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Azzaoui
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sobocinski
authors.forename: Blandine
authors.initials: B
authors.lastname: Maurel
authors.forename: Piervito
authors.initials: P
authors.lastname: D'Elia
authors.forename: Céline
authors.initials: C
authors.lastname: Perrot
authors.forename: Aurélia
authors.initials: A
authors.lastname: Bianchini
authors.forename: Matthieu
authors.initials: M
authors.lastname: Guillou
authors.forename: Stéphan
authors.initials: S
authors.lastname: Haulon
mesh_terms: D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017076:Computer-Aided Design; D057510:Endovascular Procedures / Q000295:instrumentation*; D005602:France; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging; D015607:Stents; D036542:Tomography, Spiral Computed