Antegrade in situ stent-graft fenestration for the renal artery following inadvertent coverage during EVAR

TY - JOUR

T1 - Antegrade in situ stent-graft fenestration for the renal artery following inadvertent coverage during EVAR

AU - Kölbel, Tilo

AU - Carpenter, Sebastian William

AU - Diener, Holger

AU - Wipper, Sabine

AU - Debus, Eike Sebastian

AU - Larena-Avellaneda, Axel

PY - 2013/6

Y1 - 2013/6

N2 - PURPOSE: To report the use of antegrade in situ fenestration as a bailout technique to rescue a renal artery after inadvertent coverage during endovascular aneurysm repair (EVAR).TECHNIQUE: The technique is demonstrated in a patient with a 6-cm infrarenal abdominal aortic aneurysm (AAA) and a short, angulated proximal neck. A type I endoleak persisted on completion angiography after implantation of a bifurcated Zenith stent-graft despite dilation with a compliant balloon. A Giant Palmaz stent mounted on a large compliant balloon successfully resolved the endoleak. After placing the stent, the left renal artery was covered completely by the main aortic graft material, leading to only marginal opacification on angiography. To preserve flow to the renal artery, a transseptal sheath and transseptal needle were introduced from the right femoral artery and used to puncture the abdominal stent-graft antegrade at the site of the left renal artery. A 0.018-inch guidewire could then be introduced into the left renal artery; following a number of maneuvers, a balloon-expandable stent was placed through the fenestration into the target vessel. On computed tomographic angiography 4 days postoperatively, the AAA remained excluded and both renal arteries were patent, with all side branches fully preserved. Renal function was completely restored.CONCLUSION: Antegrade in situ fenestration can facilitate immediate revascularization of inadvertently covered side branches in EVAR using a transseptal sheath and needle. If the anatomical features are supportive, antegrade in situ fenestration can be a useful bailout technique.

AB - PURPOSE: To report the use of antegrade in situ fenestration as a bailout technique to rescue a renal artery after inadvertent coverage during endovascular aneurysm repair (EVAR).TECHNIQUE: The technique is demonstrated in a patient with a 6-cm infrarenal abdominal aortic aneurysm (AAA) and a short, angulated proximal neck. A type I endoleak persisted on completion angiography after implantation of a bifurcated Zenith stent-graft despite dilation with a compliant balloon. A Giant Palmaz stent mounted on a large compliant balloon successfully resolved the endoleak. After placing the stent, the left renal artery was covered completely by the main aortic graft material, leading to only marginal opacification on angiography. To preserve flow to the renal artery, a transseptal sheath and transseptal needle were introduced from the right femoral artery and used to puncture the abdominal stent-graft antegrade at the site of the left renal artery. A 0.018-inch guidewire could then be introduced into the left renal artery; following a number of maneuvers, a balloon-expandable stent was placed through the fenestration into the target vessel. On computed tomographic angiography 4 days postoperatively, the AAA remained excluded and both renal arteries were patent, with all side branches fully preserved. Renal function was completely restored.CONCLUSION: Antegrade in situ fenestration can facilitate immediate revascularization of inadvertently covered side branches in EVAR using a transseptal sheath and needle. If the anatomical features are supportive, antegrade in situ fenestration can be a useful bailout technique.

KW - Aortic Aneurysm, Abdominal/surgery

KW - Blood Vessel Prosthesis

KW - Endovascular Procedures/methods

KW - Humans

KW - Male

KW - Middle Aged

KW - Renal Artery/surgery

KW - Stents

U2 - 10.1583/13-4231R.1

DO - 10.1583/13-4231R.1

M3 - SCORING: Journal article

C2 - 23731298

VL - 20

SP - 289

EP - 294

JO - J ENDOVASC THER

JF - J ENDOVASC THER

SN - 1526-6028

IS - 3

ER -