Impact of renal arterial morphology on fluoroscopy time in chimney endovascular aneurysm repair.
Objectives To evaluate the impact of renal artery morphology on fluoroscopy time in chimney endovascular aneurysm repair. Methods Morphology of renal artery was retrospectively quantified in the preoperative CT angiography. Renal artery angulation, ostial diameter, severity of ostial stenosis, main renal artery length, and tortuosity were analyzed with a 3D workstation. The main measure outcome was fluoroscopic time as an indicator of complexity. Uni- and multivariate logistic regression analyses were performed to determine predictors of longer fluoroscopy. Secondary endpoints were amount of contrast medium, patency of renal artery, and type Ia endoleak. Results The enrolled 38 patients (mean age 75.0 years; 34 males) were stratified at the median of fluoroscopic time of 35.2 min (interquartile range, 21.5) and classified in group A ( n = 19) and group B ( n = 19) having a fluoroscopic time of 24.5 (interquartile range, 5.9) and 46.4 (interquartile range, 16.0) min, respectively. The severity of ostial stenosis (OsSte) was significantly different between group A and B of 26.3 ± 13.4% and 41.6 ± 18.0%, respectively; P < .01. ROC curve analysis revealed that 35.5% was an optimal cut-off for OsSte. The difference of renal angulation (RAng) (-22.5° and -2.0°; interquartile ranges 49 and 35; P = .13), and main renal artery length (33.4 ± 11.8 mm and 33.7 ± 14.3 mm; P = .94) were not significantly different. In multivariate analysis after dichotomizing OsSte and RAng, OsSte > 35.5% was identified as the only significant predictor for the longer fluoroscopy (HR: 4.33; 95% CI: 1.02-18.4, P = .04). As for the secondary endpoints, no significant differences were observed between the groups. No correlation between longer fluoroscopy and renal patency or type Ia endoleak was observed. Conclusion Severity of ostial stenosis seems to be a significant predictor for longer fluoroscopic time.
1 Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
Masayuki
M
Sugimoto
1 Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.|2 Clinic for Vascular and Endovascular Surgery, University Clinic of Münster, Münster, Germany.
Giovanni
G
Torsello
1 Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
Konstantinos P
KP
Donas
D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019540:Area Under Curve; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D000072226:Computed Tomography Angiography / Q000009:adverse effects; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects; D015641:Radiography, Interventional / Q000009:adverse effects; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
Endovascular aneurysm repair; chimney technique; juxtarenal aneurysm; morphology; renal artery