Bailout Renal Stenting Associated With Endovascular Aortic Repair: A Single Centre Experience

This study describes the midterm results of renal stenting as a bailout technique during endovascular aortic repair (EVAR) of abdominal aortic aneurysms.

A single centre retrospective study of renal artery rescue procedures during consecutive elective EVARs was performed in patients without pre-existing renal stenosis over a 22 year period. Demographic characteristics, aneurysm neck morphometry surgical details, technical success, peri-operative complications, re-interventions, renal function, and death during follow up were analysed.

Seven renal stents were implanted (all men; mean age 72.3 ± 7 years) in 748 EVARs (0.9%) in the study period. Two of seven (29%) patients had chronic kidney disease before the intervention. Two of seven (29%) aortic necks fulfilled hostility criteria (one case of conical neck and one case with a diameter >28 mm at renal level). The Herculink Elite (Abbott, Chicago, IL, USA) stent was used in all patients (seven of seven) (median length 18 mm, median diameter 6.14 ± 0.7 mm). Technical success was 100%, with no complications associated with the renal stenting and no peri-operative death. The two patients with chronic kidney disease presented with worsened renal function (creatinine 2.72 ± 3 mg/dL, glomerular filtration rate 62.3 ± 32) a median 17 months after the intervention, with no renal replacement therapy requirements during follow up. The renal stent patency rate was 100% after a median follow up of 21 months (range 6-92 months); no cases of renal infarction were identified on follow up imaging.

The need for bailout renal stenting during EVAR was low in this cohort. It is essential to adopt all measures that guarantee precise endograft deployment, even in favourable anatomies.