Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
J Vasc Surg. 2010 Feb;51(2):310-5. doi: 10.1016/j.jvs.2009.04.079. Epub 2009 Oct 22.
Patients undergoing repair of thoracoabdominal (TAA) or visceral aortic segment aneurysms typically require reconstruction of the renal arteries. The use of balloon expandable stents (BES) has been proposed as an alternative to endarterectomy or bypass for renal artery reconstruction (RAR) during open aortic aneurysm repair. We report technical aspects and long-term patency data for this method of right RAR during complex open aortic aneurysm repair.
During the interval July 1, 2005 to December 31, 2007, a total of 67 patients underwent right RAR using a BES during concomitant TAA (type I: n = 2 [2.9%], type II: n = 8 [11.9%], type III: n = 13 [19.4%], and type IV: n = 22 [32.8%]), juxtarenal (n = 9 [13.4%]) or suprarenal (n = 13 [19.4%]) AAA repair. Indications for RAR were orificial stenosis (n = 21 [31%]) and/or technical considerations referable to the proximal aortic suture line. Patency of the renal stent was evaluated in patients with computed tomography angiography using three-dimensional reconstruction or with abdominal duplex evaluation at follow-up.
The mean patient age was 75.1 years, 54.4% were male, and 18% of operations were in nonelective circumstances. Twenty-seven (39%) out of 67 patients had a preoperative creatinine level > or = 1.4 mg/dL. Two patients (2.9%) developed permanent renal failure postoperatively (neither related to renal artery occlusion). Mean radiologic follow-up was 405 days (11-1281) with 98% stent patency noted. One patient had an early stent occlusion noted at 1 month. An additional patient was noted to have a nonflow-limiting dissection distal to the renal stent, and another was noted to have distal migration of the stent beyond the renal ostium; however, these findings were clinically silent.
The use of BES during complex open aortic aneurysm repair affords a rapid and durable mode of RAR, obviating the need for endarterectomy and its associated technical complications.
接受胸腹主动脉（TAA）或内脏主动脉段动脉瘤修复的患者通常需要重建肾动脉。球囊扩张支架（BES）的使用已被提议作为开放主动脉瘤修复期间肾动脉重建（RAR）的内膜切除术或旁路术的替代方法。我们报告了在复杂的开放式主动脉瘤修复期间，这种右肾动脉重建（RAR）方法的技术方面和长期通畅数据。
在 2005 年 7 月 1 日至 2007 年 12 月 31 日期间，共有 67 例患者在同时进行 TAA（I 型：n = 2 [2.9%]、II 型：n = 8 [11.9%]、III 型：n = 13 [19.4%]和 IV 型：n = 22 [32.8%]）、肾下（n = 9 [13.4%]）或肾上（n = 13 [19.4%]）AAA 修复时使用 BES 进行右 RAR。RAR 的指征是口部狭窄（n = 21 [31%]）和/或与近端主动脉缝线有关的技术考虑因素。通过三维重建对接受计算机断层血管造影术的患者或通过腹部双功评估在随访时评估肾支架的通畅性。
患者的平均年龄为 75.1 岁，54.4%为男性，18%的手术为非择期手术。27 例（39%）患者术前肌酐水平>或=1.4mg/dL。2 例（2.9%）患者术后发生永久性肾功能衰竭（均与肾动脉闭塞无关）。平均放射学随访时间为 405 天（11-1281），98%的支架通畅。1 例患者在术后 1 个月发现早期支架闭塞。另 1 例患者发现肾支架远端存在非血流限制夹层，另 1 例患者发现支架远端迁移至肾口以外；然而，这些发现临床上无明显症状。
在复杂的开放式主动脉瘤修复中使用 BES 提供了一种快速且持久的 RAR 模式，避免了内膜切除术及其相关技术并发症的需要。
