Endovascular treatment of wide-necked aneurysms of the visceral and renal arteries using the double microcatheter technique via a single access route

An Anatomic Classification Scheme for Surgical Planning of Renal Artery Aneurysms

PURPOSE

Renal artery aneurysm (RAA) is a rare disease. This study proposed and evaluated a new classification for RAA to assist in surgical decision-making.

MATERIALS AND METHODS

Single-center data of 105 patients with RAAs from the vascular department of vascular surgery were collected retrospectively. A new classification scheme was proposed. Type I aneurysms arise from the main trunk, accessory branch, or first-order branches away from any bifurcation. Type II aneurysms arise from the first bifurcation with narrow necks (defined as dome-to-neck ratio >2) or from intralobular branches. Type III aneurysms with a wide neck arise from the first bifurcation and affect 2 or more branches that cannot be sacrificed without significant infarction of the kidney.

RESULTS

There was 50 (47.62%) type I, 33 (31.43%) type II, and 22 (20.95%) type III aneurysms. The classification assigned endovascular repair as first-line treatment (for type I or II), while open techniques were conducted if anatomically suitable (for type III). A kappa level of 0.752 was achieved by the classification compared with a level of 0.579 from the classic Rundback classification. Technical primary success was achieved in 100% and 96.05%, and symptoms were completely resolved in 100% and 84.85%, while hypertension was relieved in 84.21% and 72.92% of patients receiving open surgery or endovascular repair, respectively. No significant difference was observed for perioperative or long-term complications among the 3 classification types.

CONCLUSION

The new classification proved to be a convenient and effective method for facilitating choice of intervention for RAAs.

CLINICAL IMPACT

This study proposed and evaluated a new classification scheme for renal artery aneurysms, which proved to be a convenient and effective method for facilitating surgical decision-making. Coil embolization was the first-line treatment if suitable, while aneurysm resection and reconstruction with vein graft were conducted for some complex lesions. The safety and efficacy of both open and endovascular methods were validated.

Outcomes of endovascular, open surgical and autotransplantation techniques for renal artery aneurysm repair: a systematic review and meta-analysis

BACKGROUND

Renal artery aneurysms (RAA) can be repaired with endovascular exclusion (EVR), open repair (OR), or ex-vivo repair with renal autotransplantation (ERAT). This systematic review compares repair indications, aneurysm characteristics, and complications following these interventions.

METHODS

A systematic review of databases including MEDLINE, PUBMED, and EMBASE by two independent reviewers for studies from January 2000-November 2022. All studies evaluating repair indications, RAA morphology, morbidity and mortality following EVR, OR, and ERAT were included.

RESULTS

A total of 38 studies were included with 1540 EVR, 2377 OR and 109 ERAT subjects. Increasing aneurysm size, or diameters >20 mm, were the most common repair indications across EVR and OR (n = 537; 48%), and ERAT (n = 23; 52%). All ERAT repairs were at or distal to renal artery bifurcations (n = 46). Meta-analyses demonstrated significantly shorter length of stay (LOS) with EVR compared to OR (mean difference -4.06, 95% confidence interval (CI) -5.69 to -2.43, P < 0.001). No significant differences were found in mean aneurysm diameter (P = 0.23), total complications (P = 0.17), and mortality (P = 0.85). Major complications (Clavien-Dindo ≥III) across studies most commonly included acute renal failure (EVR 4.9% vs. OR 7.0%). Nephrectomy was the most common major complication in ERAT (5.5%).

CONCLUSIONS

Outcomes following EVR and OR of RAAs are comparable. EVR offers a shorter LOS, with no difference in morbidity or mortality. ERAT is currently only utilized for distal RAAs, however carries higher risk of infarction and nephrectomy necessitating specialized expertise or algorithms to assist appropriate selection of repair methods.

Safety and Efficacy of the Double Microcatheter Technique for Splenic Artery Aneurysms: A Single-center Retrospective Study

PURPOSE

We aimed to assess the safety and efficacy of the double microcatheter technique in the treatment of saccular splenic artery aneurysms.

METHODS

From November 2013 to October 2020, 56 patients with saccular splenic artery aneurysms underwent endovascular treatment with the double microcatheter technique at our institution. Technical success was defined as embolization of the aneurysmal cavity with no obstruction of the parent artery. Clinical success was defined as no deaths due to splenic artery aneurysms, and no reintervention, recrudescence or organ dysfunction at 1, 6, and 12 months.

RESULTS

The technical success rate was 100%. No major complications related to angiography or embolization were observed. Minor complications included fever, pain, and nausea, and 13 patients developed minor complications. At 1 month, the rate of clinical success was 96.4%. At 6 and 12 months, the clinical success rate was 92.9%. There were no aneurysmal recurrences or necessities of reintervention.

CONCLUSIONS

Coil embolization with the double microcatheter technique is a safe and effective modality for treating saccular splenic artery aneurysms and offers a reasonable choice for patients who want to retain their original hemodynamics.

Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms

We report the cases of 2 female patients, 45-year-old and 49-year-old, affected by wide-necked splenic aneurysm. We embolized the 2 lesions assisted by a new scaffolding neurovascular device, the Cascade Net, an innovative –occlusive remodeling device for temporary bridging in endovascular coil embolization of intracranial aneurysms. Visceral artery aneurysms are rare with an estimated prevalence of 2%-3% in imaging series and up to 10% in autopsy series. Most are asymptomatic and their diagnosis is occasionally. Aneurysm spontaneous rupture has been demonstrated in 2%-10% of cases and it can result in significant morbidity and mortality. Conservative management and open repair were the preferred treatment options for many years. Endovascular repair has been increasingly used since 2000; and the most widespread method of treatment has been coiling. Because of tortuosity of the parent artery, wide neck, and unfavorable locations at arterial branch points, 6% of Visceral and renal artery aneurysms VRAA cannot be adequately treated by simple coiling and requires parent artery remodeling through balloon occlusion, stent placement or parent vessel occlusion, leading to, in the latter situation, a compromised organ perfusion. Increasingly, balloon-assisted, and stent-assisted approaches as well as novel scaffolding neurovascular devices such as the Cascade Net, have allowed wide necked aneurysms to be bridged during endovascular treatment with smaller delivery system, averting parent artery occlusion and risk of distal embolization.

Coil embolization of renal artery aneurysms: Simultaneous delivery of three microdevices with a novel 6-Fr guiding sheath

Here, we report the case of a 59-year-old male patient who underwent transcatheter embolization of bilateral renal artery aneurysms, using 2 microballoons and 1 microcatheter, all carried within a single guiding sheath. During coil embolization in a visceral artery, there are situations that can require multiple microdevices. We developed a new 6-Fr Shephard-hook type guiding sheath (Parent Plus 60) with a lumen large enough to deliver three microdevices simultaneously. This technique can be used broadly in different clinical scenarios, and it may provide novel treatment strategies to clinicians in the future.