Renal Fenestration Closure Technique in Fenestrated Endovascular Repair for Pararenal Aortic Aneurysm

Ann Vasc Surg. 2018 May:49:317.e9-317.e14. doi: 10.1016/j.avsg.2017.10.023. Epub 2018 Feb 5.

Abstract

Purpose: To describe an endovascular technique to close a renal artery fenestration during fenestrated endograft implant for a pararenal abdominal aortic aneurysm (p-AAA) without interfering with other visceral vessels.

Report: A 76-year-old man with p-AAA underwent repair by a 4 fenestrations custom-made endograft. At the intraprocedural angiography, the right renal artery was occluded. To avoid a high-flow endoleak from fenestration, we performed the following technique: a 9F-steerable sheath was used to advance a 7F sheath through the fenestration into aneurism. A balloon-expandable covered stent was deployed across the fenestration and then occluded by 2 vascular plugs. At the completion angiography, there was no endoleak from the right renal fenestration, and at 6-month period, p-AAA remained completely excluded.

Conclusions: The present technique can be a safe and effective therapeutic option to propose in cases of impossible target visceral vessels cannulation during p-AAA repair using a custom-made device to avoid the aneurysmal sac perfusion.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods*
  • Computed Tomography Angiography
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Humans
  • Male
  • Prosthesis Design
  • Renal Artery / diagnostic imaging
  • Renal Artery / surgery*
  • Stents
  • Treatment Outcome