Renal artery occlusion after complex endovascular aortic repair: A narrative review
DOI:
https://doi.org/10.48750/acv.687Keywords:
BEVAR, FEVAR, Endovascular complex repair, Renal stent occlusionAbstract
INTRODUCTION: Fenestrated and branched endovascular aneurysm repair (F/BEVAR) has become the preferred treatment for most patients with complex aortic aneurysms. Although overall technical success rates exceed 95%, renal arteries remain the most vulnerable target vessels, with higher rates of instability and occlusion than mesenteric arteries. We aimed to review the current literature on renal artery bridging stent occlusion after F/BEVAR, focusing on the incidence, anatomical factors contributing to instability, and outcomes of reintervention strategies.
METHODS: We conducted a narrative review, drawing on data from large cohort studies, systematic reviews, and multicenter registries. Key endpoints included technical success, target vessel instability, primary and secondary patency rates, incidence of acute renal occlusion, reintervention techniques and timing, and renal functional outcomes.
RESULTS: Renal arteries show a higher incidence of target vessel instability, up to 7%, compared with 5% for the superior mesenteric artery and 4% for the celiac trunk. Anatomical factors, including diaphragmatic motion, distal segment mobility, and aortic remodeling, contribute to cyclic tension and branch instability. Additionally, fenestrations have shown higher primary patency rates than directional branches. Acute renal stent occlusion often presents asymptomatically, complicating timely diagnosis. However, studies indicate that revascularization, even after median ischemia times of 27.5 hours, is associated with high technical success rates (up to 95.7%) and can lead to significant recovery of renal function, particularly in patients with bilateral occlusion or a solitary kidney.
CONCLUSIONS: Despite high overall patency rates, renal arteries remain particularly susceptible to post-F/BEVAR occlusion. Acute occlusions, often clinically silent, may benefit from reintervention after prolonged ischemia, owing to the protective effect of renal collateral networks. Standardized reporting of occlusion characteristics and reintervention techniques is essential to optimize renal outcomes after F/BEVAR.
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