Endovascular abdominal aortic aneurysm repair and embolization of a pararenal aneurysm

Abdo Farret Neto,Antonio Anderson Fernandes Freire,Marcio Villar De Freitas

doi:10.1590/jvb.2013.056

Abstract

), less than 60% of predicted capacity. An infrarenal abdominal aortic aneurysm with a 4.8 cm diameter was diagnosed by Doppler ultrasound. On physical examination, the patient’s general condition was regular, the abdominal aorta was hyperpulsatile and the left pedal pulse was absent, although all other pulses were present and symmetrical. Since the AAA diameter was less than 5.5 cm at this consultation, the patient was given advice on lifestyle habit changes, such as walking and giving up smoking. The medication he was already on was maintained (atenolol, enalapril and metformin) and a return appointment for ultrasound examination was scheduled for 6 months later.At the return consultation, Doppler ultrasound showed that the aneurysm had increased in size by 6 mm in five and a half months, and had a 5.4cm diameter. Angiotomography (Angio-TC) was requested and showed a secondary aneurysm sac in a pararenal position

Highlights

Juxtarenal or pararenal aneurysms begin at the level of the renal arteries and do not afford a large enough neck for conventional endovascular treatment[1,2]
After the secondary pararenal aneurysm had been completely filled with coils, the procedure was completed with placement of the left iliac branch and fixation with a 20-50×100 Coda balloon
In the case described here, the secondary pararenal aneurysm sac created an additional therapeutic challenge. Another challenge was to avoid a type I endoleak, in view of the short neck. These difficulties were surmounted by customizing an stent with double proximal free flow, in order to provide better support for fixation, and by filling the proximal aneurysm sac with coils

Summary

Introduction

Juxtarenal or pararenal aneurysms begin at the level of the renal arteries and do not afford a large enough neck for conventional endovascular treatment[1,2]. An infrarenal abdominal aortic aneurysm with a 4.8 cm diameter was diagnosed by Doppler ultrasound. Angiotomography (Angio-TC) was requested and showed a secondary aneurysm sac in a pararenal position (Figure 1).

Results

Conclusion