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

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.

Rapid endovascular bailout revascularization of the renal arteries with a steerable guiding sheath after endovascular abdominal aortic aneurysm repair

“…A similar approach is the 'encroachment' technique, where the renal stent is placed to force the encroaching proximal edge of the aortic stent down towards the aneurysm 6 . Parallel and encroachment in the context of renal bailout are well described in the current literature [6][7][8][9][10][11][12][13][14][15] (Figure 3). Renal access in these cases was attained by direct cannulation of the vessels from either a femoral or brachial approach; none have mechanically altered the main body of the aortic stent-graft post-deployment with steerable devices to permit arterial access.…”

Renal rescue after inadvertent coverage during endovascular aneurysm repair

“…Stent or covered stent placement has become increasingly common when the artery is approachable. 2 , 3 , 4 , 5 However, accessing vessels obstructed by stent grafts can be challenging. Some reports suggest puncturing the graft using the Brockenbrough procedure, 6 , 7 and others describe fenestration of grafts with a laser catheter.…”

Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass

“…Conversion to open surgery is a rare event in EVAR, ranging from 0.8% to 5.9%. 22 , 23 Once open, an endovascular stent may be placed through puncture of a surgically exposed renal artery, 24 or a bypass may be performed. Although the suprarenal aorta is an option for proximal anastomosis of renal bypass, 25 disadvantages include clamping requirement, further ischemia to the kidneys, and challenging dissection.…”