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. 2014:2014:710742.
doi: 10.1155/2014/710742. Epub 2014 Dec 3.

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment

Umberto Marcello Bracale  1 , Anna Maria Giribono  1 , Gaetano Vitale  1 , Donatella Narese  1 , Gianpaolo Santini  2 , Luca Del Guercio  1
Affiliations

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment

Umberto Marcello Bracale et al. Case Rep Vasc Med. 2014.

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.

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Figures

Figure 1
Figure 1
Preoperative angio-CT scan showing a 6 cm abdominal aortic aneurysm suitable for EVAR.
Figure 2
Figure 2
Completion angiogram after stent-graft deployment showing type 1a endoleak (a). After aortic cuff extension placement, both renal arteries were covered (arrows) (b).
Figure 3
Figure 3
Successful recanalization (a) and stent placement (b) into right renal artery from left brachial approach.
Figure 4
Figure 4
Left retroperitoneal approach: abdominal incision for left retroperitoneal approach to the renal artery (a). Surgical exposure of the main trunk of the left renal artery (b). Retrograde insertion of a 5 Fr short sheath and subsequent 6 mm × 18 mm balloon expandable stent deployment (c).
Figure 5
Figure 5
Retrograde cannulation of the left renal artery with a 4 Fr JR catheter; injection of contrast medium through the catheter confirming the successful reentering into the aorta (a). Completion angiogram after retrograde bare metal stent placement confirming patency of the renal artery (b).
Figure 6
Figure 6
The angio-CT scan at the 3-month follow-up showing patency of renal stents and nice perfusion of both kidneys with no evidence of any endoleak.
See this image and copyright information in PMC

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