Limits...
Postoperative "Chimney" for Unintentional Renal Artery Occlusion after EVAR.

Franchin M, Fontana F, Piacentino F, Tozzi M, Piffaretti G - Case Rep Vasc Med (2014)

Bottom Line: Renal artery obstruction during endovascular repair of abdominal aortic aneurysm using standard device is a rare but life-threatening complication and should be recognized and repaired rapidly in order to maintain renal function.Both conventional surgery and endovascular stenting have been reported.We report a case of late postoperative bilateral "chimney" to resolve a bilateral thrombosis of the renal artery following an uncomplicated endovascular aortic repair.

View Article: PubMed Central - PubMed

Affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Via Guicciardini 9, 21100 Varese, Italy.

ABSTRACT
Renal artery obstruction during endovascular repair of abdominal aortic aneurysm using standard device is a rare but life-threatening complication and should be recognized and repaired rapidly in order to maintain renal function. Both conventional surgery and endovascular stenting have been reported. We report a case of late postoperative bilateral "chimney" to resolve a bilateral thrombosis of the renal artery following an uncomplicated endovascular aortic repair.

No MeSH data available.


Related in: MedlinePlus

Selective angiography at the proximal extremity of the EG (a) showed the overstenting (arrows) of the origin of both the renal arteries. Complete revascularization after bilateral stenting (b). Follow-up CT-A: complete reperfusion of the parenchyma (c) as well as persistent exclusion of the aneurysm and absence of endoleak (d).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4247940&req=5

fig3: Selective angiography at the proximal extremity of the EG (a) showed the overstenting (arrows) of the origin of both the renal arteries. Complete revascularization after bilateral stenting (b). Follow-up CT-A: complete reperfusion of the parenchyma (c) as well as persistent exclusion of the aneurysm and absence of endoleak (d).

Mentions: A 73-year-old man was admitted to our department with a diagnosis of an asymptomatic 57 mm fusiform abdominal aortic aneurysm (AAA). Medical history was notable for obesity, hypertension, chronic depressed (<30%) left heart dysfunction, and chronic obstructive pulmonary disease. Preoperative computed tomography angiography (CT-A) highlighted the presence of a hostile proximal aortic neck characterized by a reversed tapered shape (Figures 1(a) and 1(b)) plus an acute β-angle > 60° (Figure 1(c)). In the operating room, a 28 mm transrenal bifurcated EG (Endurant-Medtronic; Santa Rosa-CA; USA) was implanted through conventional bilateral groin cut-down. Final angiography confirmed the complete exclusion of the AAA with no evidence of proximal or distal endoleak, as well as the visualization of the renal arteries (Figures 2(a) and 2(b)). The immediate postoperative serum creatinine level was 1.48 mg/dL (range, 0.6–1.3 mg/dL; preoperative level: 1.36 mg/dL). Twelve hours later, a progressive reduction of urine output was noted; at that time, serum creatinine level increased to 3.26 mg/dL, configuring a grade 4 AKI according to the Aneurysm Renal Injury Score (ARISe) [5]. Angiography was performed immediately thereafter: it showed the occlusion of the renal artery, bilaterally. During the same procedure, we attempted an endovascular revascularization of the renal arteries, which failed because of the acute onset of a high-response atrial fibrillation causing hemodynamic instability and acute respiratory distress. The patient was transferred in the intensive care unit and started a temporary renal replacement therapy and amiodarone (Cordarone-Sanofi-Aventis; Milano-Italy) intravenously. Four days later, hemodynamic stability was recovered; at that time, a percutaneous left transbrachial approach was used to catheterize selectively the renal arteries (Figure 3(a)) with a 0.014′′ guidewire (Stabilizer-Cordis, Miami Lakes, FL, USA) coupled with a 4F vertebral catheter (Cordis; Miami Lakes-FL; USA). A 5 × 15 mm bare metal stent (Genesis-Cordis; Miami Lakes-FL; USA) was used bilaterally with the complete restoration of renal flow into the parenchyma (Figure 3(b)). The subsequent postoperative course was uneventful: the urine output improved progressively. He was discharged on day 6 postoperatively on acetylsalicylic acid (Cardioaspirin-Bayer; Milano-Italy) 100 mg/die ad infinitum. He was last seen eighteen months later; the patient is still alive, asymptomatic, and the follow-up CT-A confirmed the complete exclusion of the aneurysm without endoleaks and the patency of the renal stents with preservation of visceral flow (Figures 3(c) and 3(d)). At that time serum creatinine level was 1.38 mg/dL.


Postoperative "Chimney" for Unintentional Renal Artery Occlusion after EVAR.

Franchin M, Fontana F, Piacentino F, Tozzi M, Piffaretti G - Case Rep Vasc Med (2014)

Selective angiography at the proximal extremity of the EG (a) showed the overstenting (arrows) of the origin of both the renal arteries. Complete revascularization after bilateral stenting (b). Follow-up CT-A: complete reperfusion of the parenchyma (c) as well as persistent exclusion of the aneurysm and absence of endoleak (d).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4247940&req=5

fig3: Selective angiography at the proximal extremity of the EG (a) showed the overstenting (arrows) of the origin of both the renal arteries. Complete revascularization after bilateral stenting (b). Follow-up CT-A: complete reperfusion of the parenchyma (c) as well as persistent exclusion of the aneurysm and absence of endoleak (d).
Mentions: A 73-year-old man was admitted to our department with a diagnosis of an asymptomatic 57 mm fusiform abdominal aortic aneurysm (AAA). Medical history was notable for obesity, hypertension, chronic depressed (<30%) left heart dysfunction, and chronic obstructive pulmonary disease. Preoperative computed tomography angiography (CT-A) highlighted the presence of a hostile proximal aortic neck characterized by a reversed tapered shape (Figures 1(a) and 1(b)) plus an acute β-angle > 60° (Figure 1(c)). In the operating room, a 28 mm transrenal bifurcated EG (Endurant-Medtronic; Santa Rosa-CA; USA) was implanted through conventional bilateral groin cut-down. Final angiography confirmed the complete exclusion of the AAA with no evidence of proximal or distal endoleak, as well as the visualization of the renal arteries (Figures 2(a) and 2(b)). The immediate postoperative serum creatinine level was 1.48 mg/dL (range, 0.6–1.3 mg/dL; preoperative level: 1.36 mg/dL). Twelve hours later, a progressive reduction of urine output was noted; at that time, serum creatinine level increased to 3.26 mg/dL, configuring a grade 4 AKI according to the Aneurysm Renal Injury Score (ARISe) [5]. Angiography was performed immediately thereafter: it showed the occlusion of the renal artery, bilaterally. During the same procedure, we attempted an endovascular revascularization of the renal arteries, which failed because of the acute onset of a high-response atrial fibrillation causing hemodynamic instability and acute respiratory distress. The patient was transferred in the intensive care unit and started a temporary renal replacement therapy and amiodarone (Cordarone-Sanofi-Aventis; Milano-Italy) intravenously. Four days later, hemodynamic stability was recovered; at that time, a percutaneous left transbrachial approach was used to catheterize selectively the renal arteries (Figure 3(a)) with a 0.014′′ guidewire (Stabilizer-Cordis, Miami Lakes, FL, USA) coupled with a 4F vertebral catheter (Cordis; Miami Lakes-FL; USA). A 5 × 15 mm bare metal stent (Genesis-Cordis; Miami Lakes-FL; USA) was used bilaterally with the complete restoration of renal flow into the parenchyma (Figure 3(b)). The subsequent postoperative course was uneventful: the urine output improved progressively. He was discharged on day 6 postoperatively on acetylsalicylic acid (Cardioaspirin-Bayer; Milano-Italy) 100 mg/die ad infinitum. He was last seen eighteen months later; the patient is still alive, asymptomatic, and the follow-up CT-A confirmed the complete exclusion of the aneurysm without endoleaks and the patency of the renal stents with preservation of visceral flow (Figures 3(c) and 3(d)). At that time serum creatinine level was 1.38 mg/dL.

Bottom Line: Renal artery obstruction during endovascular repair of abdominal aortic aneurysm using standard device is a rare but life-threatening complication and should be recognized and repaired rapidly in order to maintain renal function.Both conventional surgery and endovascular stenting have been reported.We report a case of late postoperative bilateral "chimney" to resolve a bilateral thrombosis of the renal artery following an uncomplicated endovascular aortic repair.

View Article: PubMed Central - PubMed

Affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Via Guicciardini 9, 21100 Varese, Italy.

ABSTRACT
Renal artery obstruction during endovascular repair of abdominal aortic aneurysm using standard device is a rare but life-threatening complication and should be recognized and repaired rapidly in order to maintain renal function. Both conventional surgery and endovascular stenting have been reported. We report a case of late postoperative bilateral "chimney" to resolve a bilateral thrombosis of the renal artery following an uncomplicated endovascular aortic repair.

No MeSH data available.


Related in: MedlinePlus