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Dynamic Cine-Computed Tomography Angiography Imaging of Standard and Fenestrated Endografts: Differing Effects on Renal Artery Motion

Department of Vascular Surgery University Medical Center Utrecht, Division of Vascular Surgery Yale University School of Medicine, New Haven, Connecticut

Koen L. Vincken

Department of Image Science Institute University Medical Center Utrecht

Arno Teutelink, MD

Department of Vascular Surgery University Medical Center Utrecht

Eric L. G. Verhoeven, MD

Department of Surgery University Medical Center Groningen, The Netherlands

Matthias Prokop, MD

Frans L. Moll, MD

Department of Vascular Surgery University Medical Center Utrecht

Hence J. M. Verhagen, MD

Department of Vascular Surgery University Medical Center Utrecht, h.verhagen{at}erasmusmc.nl

Different endograft configurations (fenestrated, transrenal, infrarenal) may varyingly affect aortic side branch movement. Renal artery motion was evaluated with 64-slice dynamic cine-computed tomography angiography before and after endovascular aneurysm repair in 16 patients (46 renal arteries). Center-of-mass displacement of the renals was determined per heartbeat for before repair for 3 different endografts; differences were compared, with significance at P < 0.5. Preoperative renal artery motion is significant (1.2 [SD 0.5] mm, range, 0.6-2.). Neither transrenal nor infrarenal endografts alter renal artery motion compared with before repair (P < .05). Renal artery motion after fenestrated endovascular repair with renal stents reduces motion to 25% of the preoperative value (0.3 [SD, 0.1] mm, range, 0.2-0.5 mm; P = .01). Endograft implantation without stented side branches does not change renal artery motion, potentially allowing significant movement of the renal artery relative to the fenestration. Routine stenting of fenestrations limits postoperative renal artery motion to 0.3 mm, thereby preventing significant branch movement in relation the fenestration.

Key Words: dynamic computed tomography • endograft • endovascular aneurysm repair • aortic motion • renal artery • renal motion • renal pulsation • renal function • branched EVAR • fenestrated EVAR

Vascular and Endovascular Surgery, Vol. 42, No. 1, 25-31 (2008)
DOI: 10.1177/1538574407308200


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