title: Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment.
abstract: The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Umberto Marcello
authors.initials: UM
authors.lastname: Bracale
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Giribono
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vitale
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Narese
authors.affiliation: Department of Diagnostic Imaging, Section of General and Emergency Radiology, Cardarelli Hospital of Naples, 80131 Naples, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Santini
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Del Guercio