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

Bracale UM, Giribono AM, Vitale G, Narese D, Santini G, Del Guercio L - Case Rep Vasc Med (2014)

Bottom Line: Upon completing an angiogram, both renal arteries were found to be accidentally occluded.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.

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.

No MeSH data available.


Related in: MedlinePlus

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).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4269180&req=5

fig4: 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).

Mentions: A 28 mm × 14 mm E-vita abdominal stent-graft (JOTEC, Hechingen, Germany) was selected for repairing the aneurysm. In the operating theatre, the patient was put under general anesthesia at her choice and both common femoral arteries were surgically exposed. The stent-graft was deployed and the completion angiogram showed a type 1a endoleak, which was treated with a proximal aortic extension cuff (Figure 2(a)). Insertion and deployment of the aortic cuff system proved tricky with much friction due, perhaps, to severe angulation of the calcified iliac vessels and the presence of the previously implanted prosthesis. A subsequent angiogram revealed coverage of both renal arteries (Figure 2(b)). Selective catheterization of the right renal artery was achieved through left percutaneous brachial access and a 6 mm × 18 mm balloon-expandable stent (Express SD, Boston Scientific, Natick, MA, USA) deployed in a “chimney” fashion (Figures 3(a) and 3(b)). Attempts to catheterize the left renal artery failed requiring an open exposure through a left retroperitoneal surgical approach (Figures 4(a), 4(b), and 4(c)). A retrograde puncture of the occluded renal artery was carried out and a 5 Fr sheath positioned in. With a 0.035′′ wire (Zip Guidewire, Boston Scientific, Natick, MA, USA) and a JR 4 Fr catheter (Cordis, Johnson and Johnson, Miami, USA) retrograde catheterization of the occluded renal artery was performed (Figure 5(a)) and another 6 mm × 18 mm balloon-expandable stent (Express SD, Boston Scientific, Natick, MA, USA) was implanted (Figure 5(b)). Completion angiogram confirmed patency of both renal arteries stents. The puncture hole in the renal artery was closed with prolene 6-0 (Ethicon Ltd., Edinburg, UK). Total operative time of both procedures was 310 min and blood loss was 700 mL. Fluoroscopy time was 98 min and total contrast volume used was 380 mL (Visipaque 270 mg/mL, GE Healthcare B.V., Eindhoven, The Netherlands).


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

Bracale UM, Giribono AM, Vitale G, Narese D, Santini G, Del Guercio L - Case Rep Vasc Med (2014)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269180&req=5

fig4: 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).
Mentions: A 28 mm × 14 mm E-vita abdominal stent-graft (JOTEC, Hechingen, Germany) was selected for repairing the aneurysm. In the operating theatre, the patient was put under general anesthesia at her choice and both common femoral arteries were surgically exposed. The stent-graft was deployed and the completion angiogram showed a type 1a endoleak, which was treated with a proximal aortic extension cuff (Figure 2(a)). Insertion and deployment of the aortic cuff system proved tricky with much friction due, perhaps, to severe angulation of the calcified iliac vessels and the presence of the previously implanted prosthesis. A subsequent angiogram revealed coverage of both renal arteries (Figure 2(b)). Selective catheterization of the right renal artery was achieved through left percutaneous brachial access and a 6 mm × 18 mm balloon-expandable stent (Express SD, Boston Scientific, Natick, MA, USA) deployed in a “chimney” fashion (Figures 3(a) and 3(b)). Attempts to catheterize the left renal artery failed requiring an open exposure through a left retroperitoneal surgical approach (Figures 4(a), 4(b), and 4(c)). A retrograde puncture of the occluded renal artery was carried out and a 5 Fr sheath positioned in. With a 0.035′′ wire (Zip Guidewire, Boston Scientific, Natick, MA, USA) and a JR 4 Fr catheter (Cordis, Johnson and Johnson, Miami, USA) retrograde catheterization of the occluded renal artery was performed (Figure 5(a)) and another 6 mm × 18 mm balloon-expandable stent (Express SD, Boston Scientific, Natick, MA, USA) was implanted (Figure 5(b)). Completion angiogram confirmed patency of both renal arteries stents. The puncture hole in the renal artery was closed with prolene 6-0 (Ethicon Ltd., Edinburg, UK). Total operative time of both procedures was 310 min and blood loss was 700 mL. Fluoroscopy time was 98 min and total contrast volume used was 380 mL (Visipaque 270 mg/mL, GE Healthcare B.V., Eindhoven, The Netherlands).

Bottom Line: Upon completing an angiogram, both renal arteries were found to be accidentally occluded.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.

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.

No MeSH data available.


Related in: MedlinePlus