Transrenal Endovascular Aneurysm Repair–A Novel Approach for Abdominal Aortic Aneurysms with Difficult Neck Anatomy

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The endovascular approach to treating ruptured or symptomatic abdominal aortic aneurysms (AAA) with difficult neck anatomy still poses a major challenge. This study proposes and evaluates the outcomes of a novel technique, Transrenal Endovascular Aneurysm Repair (Tr-EVAR) which utilizes the top ring 'valley' and 'peak' configuration of the Anaconda stent graft to achieve proximal seal in AAAs with an unfavourable neck. All patients treated with Tr-EVAR over a period of 10 years were identified retrospectively. Demographic, clinical and outcome data were collected, and survival analysis was performed. The time-to-event was analysed using Kaplan-Meier curves for complication-free survival, reintervention-free survival, and overall survival. During the study period, 36 patients ruptured, symptomatic or large AAAs having unfavourable necks and not fit for open repair underwent Tr-EVAR. Two patients died in the first 30 days post-procedure (5.6%). The overall survival at 1 year, 3 years and 5 years were 86%, 72% and 54% respectively with a mean overall survival of 74.0 months (SE 7.8, 95% CI 58.7 - 89.3) which was comparable to chimney EVAR. The complication-free survival and reintervention-free survival at 1 year, 3 years,5 years were 75%, 61%, 42% and 78%, 64%, 45% respectively. Tr-EVAR can be considered as an off-the-shelf solution for urgent cases not fit for open repair with unfavourable neck features for standard EVAR. Careful patient selection and planning have generated acceptable immediate, mid-and long-term results comparable to those presented by chimney EVAR in the literature.