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Spiral CT during selective accessory renal artery angiography: assessment of vascular territory before aortic
R Dorffner1, S Thurnher, R Prokesch
1Department of Radiology, University of Vienna, AKH, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Insights
This study assessed accessory renal arteries and their vascular territory. Pre-implantation volume measurements accurately predicted renal infarction size after stent-graft occlusion of these arteries.
Area of Science:
- Vascular anatomy
- Interventional radiology
- Nephrology
Background:
- Accessory renal arteries are common and can be overlapped by aortic stent-grafts.
- Occlusion of these arteries may lead to renal infarction.
- Accurate assessment of their territory is crucial for patient management.
Purpose of the Study:
- To evaluate the vascular territory of accessory renal arteries.
- To determine the accuracy of pre-implantation volume measurement in predicting renal infarction size.
- To assess the feasibility of using this method to guide stent-graft placement.
Main Methods:
- Spiral CT angiography of selective accessory renal arteries was performed in four patients with abdominal aortic aneurysms.
- Vascular territory volume was quantified using CT software.
- Renal infarction volume was measured post-stent graft implantation.
Main Results:
- Supernumerary renal arteries supplied between 15% and 37% of the total renal mass.
- In two patients, stent-graft implantation occluded the accessory renal artery.
- The volume of renal infarction precisely matched the pre-calculated perfused volume.
Conclusions:
- Pre-operative CT volumetry of accessory renal artery territory is accurate for predicting renal infarction size.
- This method can aid in determining the safety of aortic stent-graft placement in relation to accessory renal arteries.
- Informed decisions regarding stent-graft placement can minimize risks of renal compromise.
Abstract:
We evaluated the vascular territory of accessory renal arteries in cases where the vessel might be overlapped by an aortic stent-graft. Spiral CT during selective accessory renal artery angiography was performed in four patients with abdominal aortic aneurysms (including one with a horseshoe kidney). The volume of the vascular territory of each renal artery was measured using a software program provided by the CT unit manufacturer. The supernumerary renal arteries perfused 32%, 37%, 15%, and 16% of the total renal mass, respectively. In two patients, stent-grafts were implanted, which resulted in occlusion of the supernumerary renal artery. The volume of the renal infarction was equal to the volume perfused by the artery as calculated before implantation of the stent-graft. The method proposed is accurate for estimating the size of the expected renal infarction. It might help to determine whether placement of a stent-graft is acceptable.