Endovascular robotic treatment of renal artery disease by Dr. Sung Wan Ham with the Magellan Robotic Catheter System by Hansen Medical. Learn more by visiting us at www.hansenmedical.com


Transcript (partial):
Hello. I'll be discussing two cases of renal artery interventions using the Magellan Robotic System. Our first case, involves a 76-year-old gentleman, who underwent an endovascular aortic aneurysm repair including a right renal artery snorkel to establish a steel for the EVAR. The patient also had a concurrent left renal artery high grade stenosis that was to be addressed in a separate setting. The patient had severe ischemic nephropathy with rapidly progressive oliguric renal failure with an increasing creatinine. This left renal artery high grade stenosis will address in a separate setting and was attempted from the brachial approach to perform angioplasty and stenting. However, this proved to be unsuccessful.This is just a completion aortogram after the EVAR and right renal artery snorkel, and this is shown just to illustrate the anatomy of the left renal artery high grade stenosis with the downward facing renal artery. An attempt from the brachial approach in a different setting from the EVAR was attempted approximately two weeks after the EVAR, and despite using multiple wires and catheters of low profile, as well as the low profile balloon, we're unable to cross the high grade
renal artery stenosis with a catheter. Despite having a sheath heart at the left renal artery orifice, low catheter or low profile balloon, would track over our wire. And after 107 minutes of fluoroscopy time and total procedure time of 168 minutes, the attempts were terminated and reassess for an alternative option. So we felt that the patient still needed revascularization of the left renal artery high grade stenosis to preserve his excretory renal function. Therefore, the Magellan Robotic System was considered, and mainly because of the catheter and sheath pushability that the Magellan Robotic System could offer, that mainly we have difficulty with from the brachial approach despite using multiple different wires and catheters, the shealth stability that the robot would provide having the sheath formed towards the renal artery for precise stent deployment.This is our selective run of the left renal artery high grade stenosis, using the Magellan Robotic catheter. You can see that the robotic leader is already engaged into the left renal artery orifice. We had great little difficulty in tracking this catheter in through this high grade stenosis. We did perform pre-dilation with a low profile balloon and after removing the leader, we had formed our sheath and parked at just up to the left renal artery orifice and positioned our balloon expandable stent where we want it. And this is post-deployment. We see a good attempted result with minimal residual stenosis and an excellent nephrogram, and this was performed using the Magellan Robotic System with a fluoroscopy time of 25.2 minutes, constrast of 45 cc and a total procedure time of about 100 minutes, and using the robotic system, we really did not use any other catheter other than the robot and only one type of wire, which is a 0.018 thermal gold wire. And just comparing the two approaches, the conventional approach from the brachial and the robotic approach in the thermal, we can see the fluoroscopy time is about a quarter compared to the brachial approach. Total procedure time is about an hour less with a little bit more contrast with the robotic approach because we cannot use CO2 contrast. I do want to emphasize that the conventional manual approach from the brachial was a really dedicated session, just to address the left renal artery stenosis apart from the original EVAR.

So in summary, the Magellan
robotic system allowed successful angioplasty and stenting of a high grade left renal artery stenosis, after a manual failed attempt from the brachial approach. The Magellan robotic system provided the sheath and catheter pushability that was unable to be performed using manual techniques coming from the arm. Using the robotic catheter, we did avoid any manipulation of existing right renal artery, stent, and EVAR device, and that proved to be no problem at all. And in conclusion using the robotic system for the left renal artery stenosis from the groin approach proved to be expeditious and potentially less radiation exposure to all staff and patient in the room. And most importantly the patient did preserve his excretory renal function at least in the short term, he made 800 cc of urine that night.

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