title: Proximal type I endoleak after previous EVAR with Palmaz stents crossing the renal arteries: treatment using a fenestrated cuff.
abstract: OBJECTIVE
  To report the use of a fenestrated cuff for endovascular treatment of a proximal type I endoleak after previous endovascular aneurysm repair (EVAR) that included 2 suprarenal cuffs and 2 Palmaz stents.
  
  
  METHODS
  A 71-year-old man had been treated for an infrarenal abdominal aortic aneurysm with a Powerlink stent-graft, 2 additional proximal cuffs with suprarenal fixation, and 2 Palmaz stents extending over the renal arteries. Follow-up demonstrated a type I endoleak and an increase in aneurysm size. A 2-stage endovascular approach featuring a fenestrated cuff was undertaken. Prior to the endoleak repair procedure, both renal arteries were catheterized and the Palmaz stent struts dilated. When the customized fenestrated cuff was available, it was successfully positioned with covered stents in the fenestrations, completely excluding the proximal type I endoleak.
  
  
  CONCLUSIONS
  Fenestrated stent-grafting is a viable alternative to open repair after failed EVAR, even when previously implanted bare metal stents cross the renal orifices.
authors.affiliation: Department of Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Germany.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Oikonomou
authors.forename: Balasz
authors.initials: B
authors.lastname: Botos
authors.forename: Umberto M
authors.initials: UM
authors.lastname: Bracale
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome