No abstract

Purpose: Kidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up. Material and methods:A total of 214 endovascularly treated AAA patients were included. In all cases, pre-and postoperative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years. Results:The baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m 2 . Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endovascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance.Conclusions: Angio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.

The current laser atherectomy technologies to treat patients with challenging (to‐cross) total chronic occlusions with a step‐by‐step (SBS) approach (without leading guide wire), are lacking real‐time signal monitoring of the ablated tissues, and carry the risk for vessel perforation. We present first time post‐classification of ablated tissues using acoustic signals recorded by a microphone placed nearby during five atherectomy procedures using 355 nm solid‐state Auryon laser device performed with an SBS approach, some with highly severe calcification. Using our machine‐learning algorithm, the classification results of these ablation signals recordings from five patients showed 93.7% classification accuracy with arterial vs nonarterial wall material. While still very preliminary and requiring a larger study and thereafter as commercial device, the results of these first acoustic post‐classification in SBS cases are very promising. This study implies, as a general statement, that online recording of the acoustic signals using a noncontact microphone, may potentially serve for an online classification of the ablated tissue in SBS cases. This technology could be used to confirm correct positioning in the vasculature, and by this, to potentially further reduce the risk of perforation using 355 nm laser atherectomy in such procedures.