Antegrade in situ stent-graft fenestration for the renal artery following inadvertent coverage during EVAR
Standard
Antegrade in situ stent-graft fenestration for the renal artery following inadvertent coverage during EVAR. / Kölbel, Tilo; Carpenter, Sebastian William; Diener, Holger; Wipper, Sabine; Debus, Eike Sebastian; Larena-Avellaneda, Axel.
In: J ENDOVASC THER, Vol. 20, No. 3, 06.2013, p. 289-294.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
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 -