192871Providence Heart and Vascular Institute, Portland, OR, USA.
Department of Biomedical Engineering, California State University, Long Beach, CA, USA.
Vascular. 2023 Apr;31(2):234-243. doi: 10.1177/17085381211059978. Epub 2021 Dec 28.
Practice patterns and durability of parallel stent graft techniques in complex endovascular aneurysm repair (EVAR) remain poorly defined. We aimed to quantify and compare the impact of renal chimney intra-aortic stent length (IASL) on geometric deformations of renal arteries in complex EVAR.
Thirty-eight nonconsecutive patients underwent EVAR utilizing parallel stent graft techniques (chimney EVAR [chEVAR], = 28; chimney endovascular aneurysm sealing [chEVAS], = 10) between 2010 and 2016. A total of 59 renal chimney stent grafts were used. Geometric quantification was derived from three-dimensional model-based centerline extraction. Renal chimney intra-aortic stent length (IASL) was defined as the length of chimney stent that extended from the proximal edge of the chimney stent to the ostium of the corresponding renal artery.
Mean IASL for both left and right renal arteries in the cohort was 35.7 mm. Renal arteries containing chimney IASL <30 mm trended toward a greater branch angle (135.4 vs. 127.8°, = .06). Left renal arteries showed significantly greater branch angle among those with IASL <40 mm (135.5 vs. 121.7°, = .045). Mean IASL for renal arteries in chEVAR was significantly longer compared to chEVAS (39.2 vs. 26.3 mm, = .003). No difference was noted in overall branch angle or end-stent angle based on procedure type. ChEVAR with IASL <30 mm had significantly greater end-stent angle (48.2 vs. 33.5°, = .03). In contrast, chEVAS patients showed no difference in end-stent angle based on IASL thresholds, but did have significantly greater branch angle among those with IASL <30 mm when grouped by both all renal arteries (133.5 vs. 113.5°, = .004) and right renal arteries (134.3 vs. 111.6°, = .02).
Renal chimney stents with longer IASL appear to exhibit less renal artery deformation, suggesting a more gradual and perpendicular transition of the chimney stent across the renal ostium.
复杂血管内动脉瘤修复（EVAR）中平行支架移植物技术的实践模式和耐久性仍定义不明确。我们旨在量化和比较肾烟囱主动脉内支架长度（IASL）对复杂 EVAR 中肾动脉几何变形的影响。
2010 年至 2016 年间，38 例非连续患者接受了平行支架移植物技术（烟囱 EVAR [chEVAR]，n=28；烟囱血管内动脉瘤密封术 [chEVAS]，n=10）的 EVAR。共使用 59 个肾烟囱支架。几何量化是从基于三维模型的中心线提取中得出的。肾烟囱主动脉内支架长度（IASL）定义为烟囱支架从烟囱支架的近端边缘延伸至相应肾动脉的开口的长度。
该队列中左、右肾动脉的平均 IASL 分别为 35.7mm。包含 IASL<30mm 的肾动脉分支角度较大（135.4 与 127.8°，=0.06）。IASL<40mm 的左肾动脉分支角度明显较大（135.5 与 121.7°，=0.045）。chEVAR 的肾动脉 IASL 明显长于 chEVAS（39.2 与 26.3mm，=0.003）。基于手术类型，整体分支角度或支架末端角度无差异。IASL<30mm 的 chEVAR 支架末端角度明显较大（48.2 与 33.5°，=0.03）。相比之下，chEVAS 患者的支架末端角度无 IASL 阈值差异，但在以所有肾动脉（133.5 与 113.5°，=0.004）和右肾动脉（134.3 与 111.6°，=0.02）分组时，IASL<30mm 的患者分支角度明显较大。
具有较长 IASL 的肾烟囱支架似乎表现出较小的肾动脉变形，表明烟囱支架在肾口处的过渡更平缓、更垂直。
