Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in XXXX .

@entity1 @entity439 @entity1755
PURPOSE: To evaluate the impact of renal chimney grafts on anatomical suitability for @entity439 repair (EVAR) in @entity1755 ( @entity1755 ). METHODS: Contrast-enhanced computed tomography images of 206 @entity1 with @entity1755 [175 @entity1 (mean age 75  7.8 years) and 31 @entity1 (mean age of 76  7.5 years)] were evaluated in a dedicated 3-dimensional vascular workstation. Assessment of infrarenal EVAR suitability was based on predefined anatomical variables reflecting the Instructions for Use of commercially available stent-grafts. In @entity1 where @entity439 neck length was the only limiting factor for suitability, reevaluation of the proximal sealing zone was done, accounting for chimney grafts in one or both renal arteries. RESULTS: Seventy (34%) @entity1755 @entity1 were anatomically suitable for EVAR: 65 (37%) of 175 @entity1 and 5 (16%) of 31 @entity1 (p<0.01). Eighty-nine (65%) of the 136 unsuitable @entity1 had @entity439 necks <15 mm long; short neck was the only exclusion criterion in 33 (24%) cases. In the 33 short-necked @entity439 without other limiting factors, a proximal sealing zone >15 mm could potentially be achieved with one or two renal chimney grafts in 12 (36%) and 25 (76%) @entity1 , respectively, increasing overall suitability to 40% and 46%. If access issues could also be solved and a similar strategy with chimneys for the renal arteries was applied, the EVAR suitability would increase further to 58%. CONCLUSION: Roughly one third of @entity1 with @entity1755 are anatomically suitable for EVAR; short @entity439 neck is the most common exclusion criteria. In appropriate cases, chimney grafts in one or both renal arteries may increase overall suitability by 12%. Suitability increases to ~60% when iliac access issues are additionally overcome.
