Endovaskuläre Therapie einer iatrogenen Nierenarterienperforation nach fenestrierter Aortenprothese (fEVAR)

HISTORY AND ADMISSION FINDINGS: A 75-year-old patient was initially hospitalized for therapy-evaluation of a an acquaint infrarenal abdominal-aortic-aneurysm, with a maximum diameter of 5.3 cm. Medical history showed a known contained rupture of the aneurysm. Except for a substituted Hypothyroidism and a COPD Stadium II (GOLD), there were no other previous diseases known.

EXAMINATIONS: Laboratory showed a slight normochrome, normocytic anemia (hemoglobin 13 g/dl, MCV and MCH were normal) together with a decreased total amount of erythrocytes of 3.89/pl. TSH value was increased significantly at 7.960 mU/l. Initially creatinine was measured at 1.02 mg/dl. Sonography and CT-scan of the abdominal vessels had shown no new insights other than the aneurysm of the abdominal aorta. A surgical revision was indicated.

TREATMENT AND COURSE: After primarily uncomplicated implantation of a fenestrated EVAR, the patient showed a progressive hemoglobin loss concomitant with a considerable increase of renal retention parameters. A "spurium"/false aneurysm of the right renal artery was found, which moreover showed a retroperitoneal bleeding. The patient subsequently underwent successful endovascular therapy in our clinic and was dismissed from the hospital in good condition and without further complications. Follow up controls showed no signs of new pathologies.

CONCLUSION: "Direct" post-operative complications after EVAR are a rarity. In our case, the interventional endovascular approach of the bleeding from the right renal artery was a successful and sufficient treatment of the potentially life-threatening complication.