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Multilevel Microdissection and Functional-Structural Profiling of Human Renal Arterial Branches
Published on: September 5, 2025
Early Renal Function Alterations in Renal Branches vs. Renal Fenestrations - A Dynamic Scintigraphy Based Prospective
Matteo Orrico1, Laura Cosma2, Maria Ricci2
1Department of Vascular Surgery, San Camillo-Forlanini Hospital, Rome, Italy; Department of Vascular Surgery, Policlinico Santa Maria alle Scotte, University of Siena, Italy.
Insights
Branches used in fenestrated and branched endovascular aneurysm repair (F/BEVAR) led to a significant early decrease in renal function compared to fenestrations alone. Renal function remained stable at one year post-procedure.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Imaging
Background:
- Fenestrated and branched endovascular aneurysm repair (F/BEVAR) is a complex procedure for treating complex aortic aneurysms.
- Assessing the impact of different renal artery repair configurations on kidney function is crucial for patient outcomes.
Purpose of the Study:
- To compare the early-phase renal function outcomes between fenestration and branch techniques in F/BEVAR.
- To evaluate the impact of renal artery bridging components on glomerular filtration rate (GFR).
Main Methods:
- Prospective study of 67 patients undergoing F/BEVAR from March 2018 to June 2019.
- Patients divided into fenestration and branch groups.
- Dynamic renal scintigraphy with 99mTc-DTPA performed pre-operatively, and at 3 months and 1 year post-operatively.
Main Results:
- Analysis included 135 kidneys; 63 in the fenestration group and 72 in the branch group.
- A greater mean decrease in GFR was observed at 3 months in the branch group (-23.4 mL/min) compared to the fenestration group (-6.0 mL/min).
- This GFR decrease persisted at one year, indicating sustained impact.
Conclusions:
- The use of branches for renal arteries in F/BEVAR is associated with a more pronounced early decline in GFR than fenestrations.
- Scintigraphic evidence suggests significant renal function alterations in the early phase following F/BEVAR with branches.
Objective:
The objective of this prospective single centre study was to assess whether branches and fenestrations have different outcomes on renal function in the early phase.
Methods:
From March 2018 to June 2019, 67 patients who underwent elective fenestrated and branched endovascular aneurysm repair (F/BEVAR) procedures were enrolled in this study. The patients were divided into two groups according to the renal bridging component configuration (fenestration vs. branch). All of them underwent dynamic renal scintigraphy with 99mTc diethylenetriaminepentaacetic acid (DTPA), two weeks pre-operatively, and three months and one year post-operatively. The primary end points were peri-procedural technical success, 30 day major adverse events, differences in glomerular filtration rate (GFR) between the branch and fenestration configurations, and variations between the pre-operative and the post-operative dynamic renal scintigraphy.
Results:
Overall, 135 kidneys were analysed: 63 in the 32 patients treated with fenestrations, and 72 in the 35 patients treated with branches; the mean GFR on baseline scintigraphy was 58.4 ± 30.9 mL/min in the fenestration group, and 65.1 ± 29.2 mL/min in the branch group. Only kidneys associated with a patent fenestration/branch were included in the split GFR final analysis. The mean total GFR at three month scintigraphy decreased by 6.0 ± 2.9 mL/min in the fenestration group and by 23.4 ± 6.4 mL/min in the branch group. The split GFR decreased by 3.5 ± 0.6 mL/min in the fenestration group, and by 15.4 ± 5.4 mL/min in the branch group. The GFR decrease remained stable at one year.
Conclusion:
In this study, the use of branches for renal arteries during F/BEVAR resulted in a greater decrease in the GFR than in those patients who were treated with fenestrations alone. The scintigraphic alterations were evident at an early phase.
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