Strategies to tackle unrecognized bilateral renal artery occlusion after endovascular aneurysm repair.
BACKGROUND
Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR) is an uncommon phenomenon. The sequelae from this specific complication are severe; consequently, the topic of renal artery coverage is a pertinent issue. We present a case series of patients undergoing EVAR with unintentional renal artery coverage, review the treatment options available, and suggest a treatment algorithm for this scenario based on the evidence.


RESULTS
We report four patients who were found to have renal artery occlusion after EVAR detected up to 5 weeks postoperatively. Renal revascularization was achieved using endovascular renal artery stenting in two patients, and open hepato-spleno-renal bypass in the remaining two cases. Treatment strategies used led to symptom resolution and recovery of renal function in all cases.


CONCLUSIONS
Both open and endovascular techniques may be used as procedures to treat this condition-the choice of procedure is primarily determined by accessibility of the renal orifice.
Imperial Vascular Unit, St Mary's Campus, Imperial College Healthcare NHS Trust, London, UK.
John
J
Adu
Nicholas J
NJ
Cheshire
Celia V
CV
Riga
Mohamad
M
Hamady
Colin D
CD
Bicknell
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D000800:Angioplasty, Balloon / Q000295:instrumentation; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome