Intentional coverage of a main renal artery during endovascular juxtarenal aortic aneurysm repair in symptomatic high-risk patients.
OBJECTIVE
To describe the efficacy and morbidity of intentionally covering a main renal artery during symptomatic juxtarenal endovascular aneurysm repair (EVAR).


METHODS
Two patients with symptomatic juxtarenal abdominal aortic aneurysm (AAA) were felt to be at prohibitive risk for open repair. Each underwent EVAR with intentional coverage of 1 main renal artery to achieve adequate proximal hemostatic seal. One patient died at 24 months; the second is symptom-free at 10 months. Both aneurysms initially decreased in diameter. Both patients had increased serum creatinine and required increased therapy for hypertension, but neither required hemodialysis. Renal volume decreased 48.7% and 68.0%, respectively.


CONCLUSIONS
Intentional coverage of a main renal artery during EVAR for a symptomatic juxtarenal aneurysm resulted in effective short-term AAA repair with no need for dialysis. Despite the increased requirement for antihypertensive medications and the observed decline in renal function, this technique provides an option for treatment of this difficult patient subset.
Weinberger
Jeffrey B
JB
Section of Vascular Surgery, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Long
Graham W
GW
Bove
Paul G
PG
Uzieblo
Maciej R
MR
Kirsch
Matthias J
MJ
Richey
Kenneth A
KA
Brown
O William
OW
Zelenock
Gerald B
GB
Shanley
Charles J
CJ
D058186:Acute Kidney Injury / Q000000981:diagnostic imaging / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D003404:Creatinine / Q000097:blood; D017809:Fatal Outcome; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D006977:Hypertension, Renal / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex
D003404:Creatinine