Impact of Renal Artery Angulation on Procedure Efficiency During Fenestrated and Snorkel/Chimney XXXX Repair.

@entity1 @entity8 @entity439 @entity190
PURPOSE: To determine the impact of @entity8 on time to successful renal artery cannulation and procedure efficiency during fenestrated and snorkel/chimney @entity439 repair (EVAR). METHODS: The imaging and procedure logs of 77 @entity1 (mean age 74.2 years; 63 @entity1 ) who underwent complex EVAR (24 fenestrated, 53 snorkel/chimney) from 2009 to 2013 were reviewed. Renal artery angulation was measured on preoperative computed tomographic angiography scans. Time to renal artery cannulation was retrieved from the EVAR procedure logs and compared to preoperative @entity8 and other metrics of procedure efficiency (eg, procedure time, fluoroscopy time, @entity190 , etc). In all, 111 renal arteries were available for @entity8 measurement (39 fenestrated, 72 snorkel/chimney); 22 renal cannulations were inappropriate for the comparative analyses due to concomitant visceral artery stenting (n=15), combined procedures (n=6), or unsuccessful cannulation (n=1). RESULTS: For @entity1 undergoing fenestrated EVAR, mean @entity8 was -28    21   (range +37   to -60  ), not significantly different (p=0.66) from @entity1 receiving snorkel/chimney grafts (mean -30    19  , range +22   to -65  ). Comparative analysis using median @entity8 (-30   for both groups) demonstrated that renal artery cannulation during fenestrated EVAR was performed significantly faster in arteries with less downward (>=  -30  ) angulation (16.0 vs 32.8 minutes, p=0.04), whereas cannulation in snorkel/chimneys was faster in arteries with greater downward (< -30  ) angulation (10.9 vs 17.3 minutes, p=0.05). Fenestrated EVAR cases involving less downward (>=  -30  ) @entity8 were also associated with shorter overall procedure time (187.7 vs 246.2 minutes, p=0.01) and decreased fluoroscopy time (70.3 vs 98.2 minutes, p=0.04). Immediate renal function decline, procedural complications, and postoperative issues were not associated with @entity8 . CONCLUSION: Procedural efficiency may be optimized by considering @entity8 as one of several objective variables used in the selection of an appropriate endovascular strategy. The fenestrated approach is more efficient with less downward angulation to the renal arteries, while the snorkel/chimney strategy is facilitated by more downward @entity8 .
