Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching
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Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching. / Heidemann, Franziska; Kölbel, Tilo; Debus, E Sebastian; Diener, Holger; Carpenter, Sebastian W; Rohlffs, Fiona; Tsilimparis, Nikolaos.
in: J ENDOVASC THER, Jahrgang 25, Nr. 4, 08.2018, S. 466-473.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching
AU - Heidemann, Franziska
AU - Kölbel, Tilo
AU - Debus, E Sebastian
AU - Diener, Holger
AU - Carpenter, Sebastian W
AU - Rohlffs, Fiona
AU - Tsilimparis, Nikolaos
PY - 2018/8
Y1 - 2018/8
N2 - PURPOSE: To analyze the renal function and outcome after delayed (>6 hours) endovascular revascularization of acute renal artery occlusion (RAO) in patients with fenestrated-branched endovascular aneurysm repairs (EVARs) or open visceral debranching.METHODS: A single-center retrospective analysis was conducted involving 7 patients (mean age 61 years, range 49-72; 5 women) with 9 RAOs treated with endovascular revascularization between December 2014 and March 2017. Three patients had a solitary kidney with chronic renal insufficiency; 1 patient had bilateral occlusions as the acute event. Initial aortic surgery included 5 branched and 1 fenestrated EVAR as well as 1 open visceral debranching operation. Revascularization of the RAO was performed using aspiration thrombectomy, local lysis therapy, and stent-graft relining. The median time between initial aortic surgery and RAO was 10 months (range 0.5-17).RESULTS: Median renal ischemic time to revascularization was 24 hours (range 7-168). Technical success was 100%, with 1 procedure-related access complication. Temporary dialysis dependency occurred in 4 patients. Mean in-hospital stay was 17 days (range 7-32) with 1 postoperative death at day 10 due to cardiac arrest of unknown cause. Mean follow-up was 10.3 months (range 1.5-27) in 5 of 6 discharged patients. During follow-up, 1 reintervention for recurrent occlusion was performed. At follow-up imaging, all renal arteries were patent. No permanent dialysis dependency occurred.CONCLUSION: Renal function can be salvaged by delayed revascularization for RAO with prolonged renal ischemia. The endovascular approach with aspiration thrombectomy, local lysis, and stent-graft relining is a feasible technique for revascularization after RAO in patients with fenestrated-branched EVAR or open visceral debranching.
AB - PURPOSE: To analyze the renal function and outcome after delayed (>6 hours) endovascular revascularization of acute renal artery occlusion (RAO) in patients with fenestrated-branched endovascular aneurysm repairs (EVARs) or open visceral debranching.METHODS: A single-center retrospective analysis was conducted involving 7 patients (mean age 61 years, range 49-72; 5 women) with 9 RAOs treated with endovascular revascularization between December 2014 and March 2017. Three patients had a solitary kidney with chronic renal insufficiency; 1 patient had bilateral occlusions as the acute event. Initial aortic surgery included 5 branched and 1 fenestrated EVAR as well as 1 open visceral debranching operation. Revascularization of the RAO was performed using aspiration thrombectomy, local lysis therapy, and stent-graft relining. The median time between initial aortic surgery and RAO was 10 months (range 0.5-17).RESULTS: Median renal ischemic time to revascularization was 24 hours (range 7-168). Technical success was 100%, with 1 procedure-related access complication. Temporary dialysis dependency occurred in 4 patients. Mean in-hospital stay was 17 days (range 7-32) with 1 postoperative death at day 10 due to cardiac arrest of unknown cause. Mean follow-up was 10.3 months (range 1.5-27) in 5 of 6 discharged patients. During follow-up, 1 reintervention for recurrent occlusion was performed. At follow-up imaging, all renal arteries were patent. No permanent dialysis dependency occurred.CONCLUSION: Renal function can be salvaged by delayed revascularization for RAO with prolonged renal ischemia. The endovascular approach with aspiration thrombectomy, local lysis, and stent-graft relining is a feasible technique for revascularization after RAO in patients with fenestrated-branched EVAR or open visceral debranching.
KW - Acute Disease
KW - Aged
KW - Aneurysm/surgery
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Kidney/physiopathology
KW - Male
KW - Middle Aged
KW - Prosthesis Design
KW - Recovery of Function
KW - Renal Artery Obstruction/diagnostic imaging
KW - Retrospective Studies
KW - Risk Factors
KW - Stents
KW - Thrombectomy
KW - Thrombolytic Therapy
KW - Time Factors
KW - Time-to-Treatment
KW - Treatment Outcome
U2 - 10.1177/1526602818783506
DO - 10.1177/1526602818783506
M3 - SCORING: Journal article
C2 - 29956578
VL - 25
SP - 466
EP - 473
JO - J ENDOVASC THER
JF - J ENDOVASC THER
SN - 1526-6028
IS - 4
ER -
