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. 2021 Mar 15:20:e20200120.
doi: 10.1590/1677-5449.200120.

Immediate outcome of endovascular treatment of ruptured juxtarenal aneurysm with parallel stents

Claudia Guimarães Agle  1 , César Amorim Pacheco Neves  2 , Flávia Dórea Carneiro Abbehusen  3 , Tainã Lemos Andrade  3 , Filinto Marques de Cerqueira  4 , Dejean Sampaio Amorim  4
Affiliations

Immediate outcome of endovascular treatment of ruptured juxtarenal aneurysm with parallel stents

Claudia Guimarães Agle et al. J Vasc Bras. .

Abstract
in English, Portuguese

Rupture of an abdominal aortic aneurysm is an event with a high mortality rate and treatment is a medical emergency. Endovascular treatment of these aneurysms has become established as a minimally invasive alternative to classical open surgery and is now the first-choice option. However, 20 to 50% of patients with abdominal aortic aneurysms do not have anatomy favorable for endovascular treatment because of a short aneurysm neck or because visceral branches are involved by the aneurysm. We report the case of a 70-year-old patient who underwent endovascular repair of a ruptured juxtarenal aneurysm with deployment of parallel stents in the renal arteries (in a chimney technique). Clinical data and details of the procedure are reported. Technical success was achieved and there were no postoperative complications.

Resumo: A ruptura do aneurisma de aorta abdominal é um evento com alta mortalidade, e o seu tratamento nesses casos é uma emergência médica. O tratamento endovascular desses aneurismas tem se estabelecido como uma alternativa minimamente invasiva à cirurgia aberta clássica, tornando-se a opção de primeira escolha. Contudo, 20 a 50% dos pacientes portadores de aneurisma de aorta abdominal não apresentam anatomia favorável para o tratamento endovascular devido à presença de colo curto ou pelo acometimento de ramos viscerais pelo aneurisma. Relatamos um caso de uma paciente de 70 anos submetida à correção endovascular de aneurisma roto justarrenal com implante de stents paralelos para as renais (técnica de chaminé). São apresentados dados clínicos e detalhes do procedimento. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias.

Keywords: abdominal aortic aneurysm; endovascular procedures; rupture; ruptured aneurysm; stents.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Angiotomography showing a ruptured abdominal aortic aneurysm (AAA) with right-side retroperitoneal hematoma. Red arrow: aneurysm rupture (AAA wall broken). Yellow arrow: retroperitoneal hematoma
Figure 2
Figure 2. Angiotomography showing juxtarenal abdominal aortic aneurysm.
Figure 3
Figure 3. Tomographic reconstruction showing juxtarenal abdominal aortic aneurysm.
Figure 4
Figure 4. Endoprosthesis body positioned in the proximal aorta, with selective catheterization of the left renal artery.
Figure 5
Figure 5. VIABAHN self-expanding stents positioned in the renal arteries.
Figure 6
Figure 6. Endoprosthesis and self-expanding renal stents released.
Figure 7
Figure 7. Control aortography showing proximal segment of the endoprosthesis free from leaks and stents correctly positioned in the renal arteries.
Figure 8
Figure 8. Control aortography showing distal segment of the endoprosthesis free from leaks.
Figure 9
Figure 9. 30-day control angiotomography showing endoprosthesis and renal artery stents correctly positioned and free from fractures or leaks.
Figura 1
Figura 1. Angiotomografia demonstrando aneurisma da aorta abdominal (AAA) roto com hematoma retroperitoneal à direita. Seta vermelha: ruptura do aneurisma (descontinuidade da parede do AAA). Seta amarela: hematoma retroperitoneal.
Figura 2
Figura 2. Angiotomografia demonstrando aneurisma da aorta abdominal justarrenal.
Figura 3
Figura 3. Reconstrução tomográfica demonstrando aneurisma da aorta abdominal justarrenal.
Figura 4
Figura 4. Corpo da endoprótese posicionada na aorta proximal, com cateterização seletiva da renal esquerda.
Figura 5
Figura 5. Stents autoexpansíveis VIABAHN posicionados nas artérias renais.
Figura 6
Figura 6. Corpo da endoprótese e stents autoexpansíveis das renais liberados.
Figura 7
Figura 7. Aortografia de controle demonstrando seguimento proximal da endoprótese sem vazamentos e stents de artérias renais bem-posicionados.
Figura 8
Figura 8. Aortografia de controle demonstrando seguimento distal da endoprótese sem vazamentos.
Figura 9
Figura 9. Angiotomografia de controle com 30 dias mostrando endoprótese e stents de artérias renais bem-posicionados, sem fraturas e sem vazamentos.
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