Changes in renal-mesenteric duplex ultrasound velocities after fenestrated and branched endovascular aortic aneurysm repair

Titia A L Sulzer; Thanila A Macedo; Nicole Strissel; Gina K Hesley; Alexander Lekah; Tiziano Tallarita; Marina Dias-Neto; Ying Huang; Emanuel R Tenorio; Andrea Vacirca; Thomas Mesnard; Aidin Baghbani-Oskouei; Safa Savadi; Jorg L de Bruin; Hence J M Verhagen; Bernardo Mendes; Gustavo S Oderich

doi:10.1016/j.jvs.2023.06.106

Changes in renal-mesenteric duplex ultrasound velocities after fenestrated and branched endovascular aortic aneurysm repair

J Vasc Surg. 2023 Nov;78(5):1162-1169.e2. doi: 10.1016/j.jvs.2023.06.106. Epub 2023 Jul 14.

Authors

Titia A L Sulzer¹, Thanila A Macedo², Nicole Strissel³, Gina K Hesley³, Alexander Lekah³, Tiziano Tallarita⁴, Marina Dias-Neto⁵, Ying Huang⁵, Emanuel R Tenorio⁵, Andrea Vacirca⁵, Thomas Mesnard⁵, Aidin Baghbani-Oskouei⁵, Safa Savadi⁵, Jorg L de Bruin⁶, Hence J M Verhagen⁶, Bernardo Mendes⁷, Gustavo S Oderich⁵

Affiliations

¹ Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
² Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX. Electronic address: thanila.macedo@uth.tmc.edu.
³ Department of Radiology, Mayo Clinic, Rochester, MN.
⁴ Department of Vascular Surgery, Mayo Clinic, Eau Claire, WI.
⁵ Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
⁶ Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁷ Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.

PMID: 37453587
DOI: 10.1016/j.jvs.2023.06.106

Abstract

Objective: Stenting of renal and mesenteric vessels may result in changes in velocity measurements due to arterial compliance, potentially giving rise to confusion about the presence of stenosis during follow-up. The aim of our study was to compare preoperative and postoperative changes in peak systolic velocity (PSV, cm/s) after placement of the celiac axis (CA), superior mesenteric artery (SMA) and renal artery (RAs) bridging stent grafts during fenestrated-branched endovascular aortic repair (FB-EVAR) for treatment of complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms.

Methods: Patients were enrolled in a prospective, nonrandomized single-center study to evaluate FB-EVAR for treatment of complex AAA and thoracoabdominal aortic aneurysms between 2013 and 2020. Duplex ultrasound examination of renal-mesenteric vessels were obtained prospectively preoperatively and at 6 to 8 weeks after the procedure. Duplex ultrasound examination was performed by a single vascular laboratory team using a predefined protocol including PSV measurements obtained with <60° angles. All renal-mesenteric vessels incorporated by bridging stent grafts using fenestrations or directional branches were analyzed. Target vessels with significant stenosis in the preoperative exam were excluded from the analysis. The end point was variations in PSV poststent placement at the origin, proximal, and mid segments of the target vessels for fenestrations and branches.

Results: There were 419 patients (292 male; mean age, 74 ± 8 years) treated by FB-EVAR with 1411 renal-mesenteric targeted vessels, including 260 CAs, 409 SMAs, and 742 RAs. No significant variances in the mean PSVs of all segments of the CA, SMA, and RAs at 6 to 8 weeks after surgery were found as compared with the preoperative values (CA, 135 cm/s vs 141 cm/s [P = .06]; SMA, 128 cm/s vs 125 cm/s [P = .62]; RAs, 90 cm/s vs 83 cm/s [P = .65]). Compared with baseline preoperative values, the PSV of the targeted vessels showed no significant differences in the origin and proximal segment of all vessels. However, the PSV increased significantly in the mid segment of all target vessels after stent placement.

Conclusions: Stent placement in nonstenotic renal and mesenteric vessels during FB-EVAR is not associated with a significant increase in PSVs at the origin and proximal segments of the target vessels. Although there is a modest but significant increase in velocity measurements in the mid segment of the stented vessel, this difference is not clinically significant. Furthermore, PSVs in stented renal and mesenteric arteries were well below the threshold for significant stenosis in native vessels. These values provide a baseline or benchmark for expected PSVs after renal-mesenteric stenting during FB-EVAR.

Keywords: Complex abdominal aortic aneurysms; Duplex ultrasound; Peak systolic velocity; Thoracoabdominal aortic aneurysms.