Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia

Abstract

Case ReportAn 88-year-old man with an expanding, asymptomatic infrarenal AAA was referred to our institution. A computed tomogram (CT) showed a 5-cm maximal diameter of the AAA (Fig. 1). The AAA had a 25-mm-long infrarenal neck that was 23 mm in diameter proximally and 25 mm distally. The patient had a crossed-over ectopic right kidney fused with the left kidney; the ectopic RA arose directly from the AAA and was 5.3 mm in diameter. The distal aortic neck was 25 mm in diameter, and the diameters of the common iliac arteries were 11 mm (left) and 9.7 mm (right).The patient's medical history included hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and hyperlipidemia. He had also undergone multiple operations, including a transurethral prostatectomy, an exploratory laparotomy for trauma, and ventral hernia repair with use of mesh. His renal function was normal (serum creatinine level, 0.95 mg/dL; and estimated glomerular filtration rate, 75 mL/min). He was at high risk for surgery because of his comorbidities, hostile abdomen, and crossed fused ectopic kidney, so we recommended endovascular aneurysm repair (EVAR) of the AAA. We intended to preserve the ectopic RA by using the chimney technique, also called the parallel stent-grafting or snorkel technique.After we attained percutaneous access to both common femoral arteries by means of ultrasonographic guidance, we inserted 6F sheaths bilaterally. We introduced a 5F pigtail catheter into the abdominal aorta. An abdominal aortogram of the infrarenal AAA showed the ectopic right RA originating from the AAA (Fig. 2). We decided to perform EVAR with the parallel endograft oriented caudally, because the distance would be shorter and the angle less acute than if the graft were directed proximally. We then pre-closed the femoral arteries with use of a 10F Prostar ® XL vascular closure device (Abbott Vascular; Redwood City, Calif ). We inserted one 20F Gore ® DrySeal sheath (W.L. Gore & Associates, Inc.; Flagstaff, Ariz) for subsequent placement of the main endograft device through the left femoral artery, and another for snorkel and limb extension through the right femoral artery.We selectively cannulated the accessory RA with use of a 5F Renal Double Curve catheter (Cordis Corporation, a Johnson & Johnson company; Miami Lakes, Fla) and a 0.018-in Hi-Torque Steelcore Peripheral Guide Wire (Abbott Vascular). Selective

Renal ectopia as cause of diagnostic difficulties in 43-year-old man hospitalized due to suspicion of colorectal cancer

“…In the literature, there are case reports showing the technical aspects of the endovascular treatment of abdominal aortic aneurysm in patients with renal ectopia [14,15,16]. Tsuboi et al [17] reported a case of partial nephrectomy in patients with left-to-right crossed fused renal ectopia with clear cell renal cell carcinoma.…”

Endovascular aortic aneurysm repair with reversed chimney graft technique in a patient with crossed fused renal ectopia: a technical note

“…Kfoury et al . [ 9 ] and Colacchio et al . [ 10 ] placed self-expanding endografts (Viabahn Endoprosthesis, LG GORE, Delaware, USA) into RAs that arose from the AAA sacs in their cases.…”

Ruptured Abdominal Aortic Aneurysm in a Patient with Congenital Fused Pelvic Kidney: A Case Report of Emergency Endovascular Treatment

“…Also, a parallel stent graft technique has been described to perfuse an ectopic renal artery originating from the AAA in a patient with a crossover ectopic right kidney fused with the left kidney. 30 A Viabahn–Gore (W. L. Gore) endograft reinforced with balloon-expandable stents was deployed in a parallel fashion with an Endurant II–Medtronic endograft iliac limb.…”