Author + information
- Kiyonori Nanto1,
- Osamu Iida1,
- Shin Okamoto1,
- Takayuki Ishihara1,
- Tatsuya Shiraki1,
- Takuya Tsujimura1,
- Shota Okuno1,
- Koji Yanaka1 and
- Masaaki Uematsu1
Patient initials or identifier number
Relevant clinical history and physical exam
85 years old male was admitted to our hospital for treatment of juxtarenal aorticaneurysm with saccular type. Because he had several comorbidities, we selected endovascularaneurysm repair.
Pre-procedural CTimaging revealed proximal short neck which length was 5mm from left renalartery to aneurysm. Because the other side was over 15mm from right renalartery to aneurysm, we performed EVAR using chimney method for left renalartery.
We performed EVAR using Gore Excluder. At first, mainbody was implanted under the left renal artery. Next, on the proximal site, wedelivered aortic extender and Zilver stent in advance. After aortic extenderwas implanted just under the right renal artery, we implanted the Zilver stentfor left renal artery. And, final KBT (Kissing balloon technique) was done. Anyendoleak was not detected by final angiography and both side of renal arteryflow was enough. One day after procedure, serum creatinine level increased onblood test. Because we did not detect reduction of renal flow by duplexultra-sonography, we observed as contrast nephropathy. But, serum creatininelevel did not improve. Accordingly, we checked the CT imaging. We weresuspicious of right renal artery occlusion due to stent graft. And, we decided to perform re-intervention for right renalartery occlusion. We inserted 5 Frguiding sheath from right brachial artery. Initial angiogram revealed rightrenal occlusion. After wire crossing with Astato XS, we implanted 6mm baremetal stent for right renal artery. After re-intervention, renal function wasgradually improved. And, this patient was discharged 3 days after re-intervention.
We experienced renal artery occlusion of non-protected side after EVAR for juxtarenal aortic aneurysm using chimney method. Revascularization of right renalocclusion succeeds with endovascular procedure without any complication.