VascupediaVIEWS AAA Course Episode 5: EVAR – Challenging “Renal Patient”
- To learn how to manage your patient with renal insufficiency: medication, alternative imaging possibilities, role of supra- or infrarenal fixation on renal function outcome
- To discuss how to deal with accessory renal arteries, what size is worth saving and how?
- Best option in horseshoe kidney
Thank you Dr. Beropoulis and Dr. Saratzis for the nice overview! Regarding the mentioned lack of evidence in accessory renal arteries, I would like to use the opportunity and mention the study from Dr. Abu Bakr who recommended the use of chimney grafts in ARAs which supply one-third of the renal parenchyma, and having a diameter >4 mm. The work was published in JEVT in 2016 and represents as you know, dear Efthymios, our general practice in my previous Hospital in St. Franziskus Hospital in Münster for those patients. Thank you again and best regards.
Indeed! Interesting publication which shows that stenting 4mm accessory renals when the neck is adequate is feasible. The definition of what is a “clinically relevant” accessory renal remains arbitrary though. The only way to assess what constitutes “clinically relevant” in terms of accessory renal preservation in EVAR would be randomisation; however, given how rare this clinical scenario is, we would really struggle to achieve power. I think it’s a case by case judgement call… definitions will probably remain arbitrary & driven by expert opinion in this setting. To add to the complexity, assessing % of renal parenchyma supplied by a certain artery is really not very easy or accurate pre-operatively. An interesting area for future research!
Thank you for your comment Kosta!
Here is the link from that publication: https://pubmed.ncbi.nlm.nih.gov/26874178/