Search

ObjectiveTo evaluate exposure to radiation during endovascular aneurysm repair (EVAR) performed with intraoperative guidance by preoperative computed tomographic angiogram fusion.MethodsAll consecutive patients who underwent standard bifurcated (BIF) or thoracic (THO), and complex fenestrated (FEN) or branched (BR) EVAR were prospectively enrolled. Indirect dose–area product (DAP), fluoroscopy time (FT), and contrast medium volume were recorded. These data were compared with a previously published prospective EVAR cohort of 301 patients and to other literature. Direct DAP and peak skin dose were measured with radiochromic films. Results are expressed as median (interquartile range).ResultsFrom December 2012 to July 2013, 102 patients underwent standard (56.8%) or complex (43.2%) EVAR. The indirect DAP (Gy.cm2) was as follows: BIF 12.2 (8.7–19.9); THO 26.0 (11.9–34.9); FEN 43.7 (24.7–57.5); and BR 47.4 (37.2–108.2). The FT (min) was as follows: BIF 10.6 (9.1–14.7); THO 8.9 (6.0–10.5); FEN 30.7 (20.2–40.5); and BR 39.5 (34.8–51.6). The contrast medium volume (mL) was as follows: BIF 59.0 (50.0–75.0); THO 80.0 (50.0–100.0); FEN 105.0 (70.0–136.0); and BR 120.0 (100.0–170.0). When compared with a previous cohort, there was a significant reduction in DAP during BIF, FEN, and BR procedures, and a significant reduction of iodinated contrast volume during FEN and BR procedures. There was also a significant reduction in DAP during BIF procedures when compared with the literature (p

Objective The purpose of this study was to analyze immediate and long-term renal outcomes (renal function and renal events) after fenestrated (FEVAR) and branched endovascular aortic aneurysm repair (BEVAR). Methods All FEVAR and BEVAR performed between October 2004 and October 2012 were included in this study. Post-operative acute renal failure (ARF) was defined according to the RIFLE criteria. Renal volume (calculated with a 3D workstation) and estimated glomerular filtration rate (GFR) (estimated with the Modification of Diet in Renal Disease [MDRD] formula) were evaluated before the procedure, before discharge, 12 months after, and yearly thereafter. Renal stent occlusion, dissection, fracture, stenosis, kink, renal stent related endoleak, and renal stent secondary intervention were all considered "renal composite events" and analyzed. A time to event analysis was performed for renal events and secondary renal interventions. Results 225 patients were treated with FEVAR and BEVAR. Renal target vessels ( n = 427) were perfused by fenestrations ( n = 374), or branches ( n = 53). Median follow up was 3.1 years (2.9–3.3 years). Technical success was achieved in 95.5% of patients. Post-operative ARF was seen in 64 patients (29%). Mean total renal volume and eGFR at 1 year, 2 year, and 3 year follow up were significantly lower when compared with pre-operative levels (after BEVAR and FEVAR); the decrease at 3 years was 14.8% (6.7%; 22.2%) ( p = .0006) for total renal volume and 14.3% (3.1%; 24.3%) ( p = .02) for eGFR. The 30 day and 5 year freedom from renal composite event was 98.6% (95.8–99.6%) and 84.5% (76.5–89.9%) after FEVAR and BEVAR (NS). The 30 day and 5 year freedom from renal occlusion was 99.5% (96.7–99.9%) and 94.4% (89.3–97.1%) after FEVAR and BEVAR (NS). Conclusion FEVAR and BEVAR are durable options for the treatment of complex aortic aneurysms and are associated with low renal morbidity, without differences between devices types. The clinical impact of decreasing renal volume over time in these patients is yet to be fully understood.