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Durability of Renal Artery Stents in Patients with Transrenal Abdominal Aortic Endografts

Donald T. Baril, MD, Robert A. Lookstein, MD, Alfio Carroccio, MD, Sharif H. Ellozy, MD, F. Scott Nowakowski, MD, Anondo Stangl, MD, Tikva S. Jacobs, MD, Jamie Won, Victoria J. Teodorescu, MD and Michael L. Marin, MD
Mount Sinai School of Medicine, New York, NY

Objective(s): The management of renal artery stenosis in patients with abdominal aortic aneurysms continues to be complex and technically challenging despite advances in endovascular therapy. There is growing concern regarding the durability of renal artery stents in the setting of transrenal abdominal aortic endografts. This study reports a single center experience of renal artery stenting for renal artery stenosis in patients with transrenal abdominal aortic endografts.
Methods: All patients undergoing endovascular abdominal aortic aneurysm repair preceded or followed by renal artery stent placement between January 1999 and December 2005 were retrospectively reviewed from a prospectively gathered endovascular database. Patients were surveyed following renal stent procedures with Multidetector CT angiography or duplex sonography. The surveillance data was analyzed for primary patency of the renal artery stent at six months, incidence of complications, need for secondary interventions, and changes in creatinine clearance (CrCl).
Results: A total of 62 renal artery stents were placed in 56 patients (44 males/12 females) with a mean age of 77.3 years (range 61-94). Forty-one stents were placed before the endograft procedure, 8 were placed during the endograft procedure, and 13 were placed post-operatively. There were no major or minor complications related to the renal artery stent procedures. Of the 56 patients, 44 had transrenal aortic endografts and 12 had devices with infrarenal fixation. The mean follow-up period was18.5 months (range 1-73 months). Six-month primary patency, which could be evaluated for 51 renal artery stents, was 97.4% (37/38) in patients with transrenal fixation and 84.6% (11/13) in patients with infrarenal fixation. The overall rate of in-stent restenosis was 8.5% (4/47) in the transrenal fixation group and 20.0% (3/15) in the infrarenal fixation group. The overall occlusion rate was 2.1% (1/47) in the transrenal fixation group and 0% (0/15) in infrarenal fixation group. Five of six patients (83.3%) underwent successful treatment of in-stent restenosis with placement of a new stent in all 5 cases. CrCl decreased in the total group by 4.2 ± 11.8 ml/min. CrCl clearance decreased by 4.7 ± 12.0 ml/min in patients with transrenal fixation and by 2.2 ± 11.0 ml/min in patients with infrarenal fixation.
Conclusions: The presence of transrenal aortic endograft did not affect the outcome of the renal artery revascularization procedure in this cohort. Renal artery stenting in the presence of transrenal abdominal aortic endografts appears to be a safe procedure without adverse effect on renal artery stent patency or renal function.