Department of Vascular Surgery, 4th Military Clinical Hospital, Wrocław, Poland.
Department of Cardiology, Lower Silesia Specialist Hospital of Tadeusz Marciniak Emergency Medicine Center, Wrocław, Poland.
PLoS One. 2021 Apr 14;16(4):e0249549. doi: 10.1371/journal.pone.0249549. eCollection 2021.
The use of the pressure gradient measurements to assess the renal artery flow hemodynamics after chimney endovascular aortic repair (chEVAR).
The study was a prospective analysis of 37 chEVAR procedures performend in 24 patients with perirenal aortic aneurysm. In all patients the measurement of: distal renal artery pressure (Pd), aortic pressure (Pa), Pd/Pa ratio (Pd/Pa) and mean gradient (MG) between the aorta and the distal renal artery were performed. Measurements were taken with 0.014 inch pressure wire catheter before and after the chEVAR procedure. MG greater than 9 mmHg and Pd/Pa ratio below 0.90 were considered as the measures of a significant decrease in distal pressure that limited flow in renal arteries. The 6 month follow-up computed tomographic angiography (CTA) was performed in all patients to diagnose potential endoleak presence and to verify the patency of the chimney stent-grafts.
All procedures were successful, and no periprocedural complications were observed in any of the patients. The mean gradient values before and after the chimney implantation did not change significantly (6,2±2,0 mmHg and 6,8±2,2 mmHg, respectively). Similarly, no significant change in Pd/Pa values was noted with the value of 0.9 observed both before and after the procedure. All chimney stents were patent on the control CTA. Type Ia endoleak was found in 4 (10.8%) patients.
The application of the described technique seems to be a safe method which allows a direct measurement of renal artery flow hemodynamics before and after chimney implantation during the chEVAR technique. The use of covered balloon expandable stents, ensures the proper blood flow in the renal arteries during the chEVAR technique.
使用压力梯度测量来评估烟囱腔内主动脉修复（chEVAR）后肾动脉血流动力学。
这项研究是对 24 例肾周主动脉瘤患者的 37 例 chEVAR 手术进行的前瞻性分析。在所有患者中，测量了：远端肾动脉压力（Pd）、主动脉压力（Pa）、Pd/Pa 比值（Pd/Pa）和主动脉与远端肾动脉之间的平均梯度（MG）。在 chEVAR 术前和术后使用 0.014 英寸压力导丝导管进行测量。MG 大于 9mmHg 和 Pd/Pa 比值低于 0.90 被认为是远端压力显著下降的指标，这限制了肾动脉的血流。所有患者均进行了 6 个月的随访计算机断层血管造影（CTA），以诊断潜在的内漏存在，并验证烟囱支架移植物的通畅性。
所有手术均成功完成，患者无围手术期并发症。烟囱植入前后平均梯度值无显著变化（分别为 6.2±2.0mmHg 和 6.8±2.2mmHg）。同样，Pd/Pa 值也没有明显变化，术前和术后均观察到 0.9 的值。所有烟囱支架在对照 CTA 上均通畅。4 例（10.8%）患者发现 Ia 型内漏。
应用描述的技术似乎是一种安全的方法，它允许在 chEVAR 技术期间直接测量烟囱植入前后肾动脉血流动力学。使用覆盖球囊扩张支架可确保在 chEVAR 技术期间肾动脉的适当血流。
