Abstract
The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.
Highlights
Unintentional coverage of both renal arteries after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) remains one of the most undesirable complications for the vascular surgeon
We report on accidental ostial coverage of both renal arteries during EVAR and present an alternate, combined open/endovascular approach used to salvage one of the occluded renal arteries
Katzen et al first described the case of a patient who underwent infrarenal stent-graft procedure and postoperatively developed dialysis-dependent renal failure due to a retrograde migration of the device, which occluded the patient’s bilateral renal arteries
Summary
Unintentional coverage of both renal arteries after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) remains one of the most undesirable complications for the vascular surgeon. Several endovascular techniques found in the literature describe adjusting the malpositioned stent-graft or revascularizing the occluded artery [1,2,3]; to date, no consensus exists as to the best approach to resolving this occurrence. We report on accidental ostial coverage of both renal arteries during EVAR and present an alternate, combined open/endovascular approach used to salvage one of the occluded renal arteries
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