Exclusion of accessory renal arteries during endovascular repair of XXXX .

@entity1 @entity8 @entity11557 @entity101 @entity1070 @entity177 @entity439 @entity1188 @entity1011 @entity1028
OBJECTIVE: Adequate proximal neck length is important for proper endovascular treatment of @entity1028 ( @entity1028 ). Placement of endografts in @entity1028 with relatively short proximal necks may require covering the origin of accessory renal arteries. Exclusion of these arteries carries the theoretical concern of regional @entity8 associated with loss of parenchyma or worsening @entity101 . We reviewed our experience with accessory renal exclusions during @entity11557 repair to determine the frequency and severity of complications. METHODS: Complete records were available for review on 311 of 325 consecutive @entity1 treated with endovascular grafts for @entity1028 from February 6, 1996, to March 15, 2001. The presence of accessory renal arteries was ascertained from preoperative/intraoperative aortography or from computed tomographic scanning. Sizes of the accessories were measured by using the main renal arteries as a reference. Considerations for excluding the accessory renal arteries were based on the likelihood of successful proximal attachment to healthy aorta, an accessory vessel whose size does not exceed the diameter of the main renal artery, and the absence of @entity8 . RESULTS: The mean follow-up was 11.5 months. Fifty-two accessory renal arteries were documented in 37 @entity1 (12%), ranging from 1 to > or =3 per @entity1 . Of these, 26 accessory renal arteries were covered in 24 @entity1 . @entity1 ranged in age from 57 to 85 years (mean, 74.1 years), with 20 @entity1 and 4 @entity1 . The Ancure device was used in 23 @entity1 and the Excluder device in one. Of the accessories excluded, 22 originated above the @entity439 and 4 originated directly from the @entity439 itself. There were no perioperative mortalities. One @entity1 died 5 months after surgery from an unrelated condition. There was one type I (distal) endoleak and no @entity1070 . Five @entity1 (21%) had @entity1188 associated with the side of @entity8 . Only one @entity1 with segmental @entity1188 had significant postoperative @entity101 that resulted in changes in blood pressure medication. The blood pressure reverted to normal 3 months later. One @entity1 with a stenotic left main renal artery required exclusion of the @entity8 for successful proximal attachment. Serum @entity1011 levels remained unchanged throughout follow-up in all but one @entity1 , in whom progressive @entity177 developed despite normal renal flow scan, presumably from intraoperative manipulation and contrast @entity8 . CONCLUSION: Exclusion of accessory renal arteries to facilitate @entity11557 repair appears to be well tolerated. Long-term sequelae seem infrequent and mild.
