Urgent interventional bilateral renal artery fenestration for giant pararenal abdominal aortic aneurysm with upper digestive tract obstruction

Abstract

During the past 20 years, open repair has been the chief intervention for pararenal abdominal aortic aneurysm (AAA). Endovascular repair has become an alternative for patients with ruptured AAA or other acute disease complications. The present study, however, attempted to use a common stent graft with the fenestration technique, rather than a customized one, in an emergency situation, to treat a giant pararenal AAA complicated by upper digestive tract obstruction, and assessed the results. A patient with a pararenal AAA was admitted emergently, with complications of upper digestive tract obstruction, including a tumor-like dilated segment of the abdominal aorta, 0.5-cm inferior to the ostia of the bilateral renal arteries, with a maximum diameter of 10.1 cm and a length of 18.5 cm. The patient underwent endovascular repair with a fenestrated endovascular stent graft to open the bilateral renal arteries 1 week later in an emergency situation. No stenosis occurred at the openings of bilateral renal artery as a result of the stent, and the AAA was completely occluded. The patient experienced greatly ameliorated abdominal pain and upper digestive tract obstruction. At the 1-year follow-up examination, no exceptional symptoms were observed. These results showed that for patients with a pararenal AAA who are unfit for open repair, or for those who cannot wait longer than 6 weeks for a customized fenestrated stent graft to be made, emergency field fenestration is feasible and successful, based on selection of the proper patient and accurate intraoperative localization.