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Prospective Evaluation of Duplex Ultrasound of Mesenteric and Renal Artery Targets in Patients Treated by Fenestrated and Branched Stent Grafts
Aaron C. Baker, MD, Gustavo S. Oderich, MD, Thanila A. Macedo, MD, Terri J. Vrtiska, MD, Bernardo C. Mendes, MD, Grant M. Spears, BS, Janet M. Hofer, BS, RN, Laurel A. Carlson, RN, Wigham R. Jean, RN.
Mayo Clinic, Rochester, MN, USA.
OBJECTIVES:To define duplex ultrasound (DUS) velocity measurements before and after stenting of mesenteric and renal artery target vessels in patients treated by fenestrated and branched endovascular repair(F-BEVAR).
METHODS: Patients (65 male, 20 female; mean age 72.9±15.7 years old) treated by F-BEVAR were included in a prospective, non-randomized study from November 2013 to July 2015. DUS were performed in a single IAC Accredited facility using a standardized protocol (Figure 1A) pre operatively and post operatively at 6 weeks , 6 months and 12 months intervals. Multiple peak systolic velocity (PSV) measurements were made along each artery (Figure 1A). Available DUS data, including peak systolic velocities (PSV) for celiac artery (CA), superior mesenteric artery (SMA), right (RRA) and left renal artery (LRA) were reviewed. Computed tomography angiography (CTA) was obtained at each interval and reviewed independently by a vascular radiologist.
RESULTS: F-BEVAR was technically successful in all patients with no mortality. All 326 targeted vessels were widely patent by completion angiography. A total of 222 DUS studies were analyzed (mean of 2.6±1.1 DUS/patient). Mean pre-operative PSVs were 150±63cm/s for CA, 126±60cm/s for SMA, 98±56cm/s for RRA and 101±85cm/s for LRA. After the procedure, there was no significant change in median PSV for all vessels at 6 weeks, 6- or 12-month intervals (P>0.1, Figure 1B). After a mean follow up of 6±5 months, there were 3 target vessel stent occlusions (2 RRAs, 1 LRAs) and 4 in-stent stenosis (1 SMA, 2 LRA, 1 RRA).
CONCLUSIONS:DUS is an effective modality to evaluate stented renal and mesenteric arteries after F-BEVAR. Velocity measurements of native vessels do not significantly change after stenting and during short-term follow up. This study establishes an expected range of PSV after stenting mesenteric and renal arteries for F-BEVAR. Ongoing patient enrollment and follow up in this prospective data collection will continue to yield further data.
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