title: Retrograde Target Vessel Catheterization as a Salvage Procedure in Fenestrated/Branched Endografting.
abstract: OBJECTIVE
  To present retrograde target vessel catheterization as a bailout technique in fenestrated and branched endografting (F/B-EVAR).
  
  
  METHODS
  Between November 2003 and November 2014, 11 (1.6%) of 671 consecutive patients with juxtarenal, suprarenal, and thoracoabdominal aortic aneurysms required retrograde target vessel access as a bailout measure during F/B-EVAR due to failure of an antegrade approach. The target vessels involved the left renal artery (LRA) in 6 patients, the celiac artery (CA) in 3 patients, the right renal artery (RRA) in 1 patient, and both renal arteries in 1 patient.
  
  
  RESULTS
  The target vessels were successfully catheterized and secured with stent-grafts in 10 patients; a single case was unsuccessful because the fenestration was in the wrong position and blocked against the arterial wall. One (9.1%) patient died within 30 days. Major perioperative complications occurred in 6 patients, including 3 with renal function deterioration, 2 with access-site wound dehiscence, and a case of pneumonia. Median hospital stay was 20 days (range 7-60) and median intensive care unit stay was 2.5 days (range 0-9). Over a mean 26-month follow-up (range 1-60), one unrelated death occurred. Reintervention was required in 1 patient due to progression of an aneurysm of the right iliac artery.
  
  
  CONCLUSIONS
  Retrograde target vessel access in F/B-EVAR is a feasible bailout procedure when antegrade cannulation fails. Secondary technical success is high, but the procedure is associated with higher perioperative morbidity and longer hospital stay.
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Oikonomou
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Katsargyris
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Clayton J
authors.initials: CJ
authors.lastname: Brinster
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Renner
authors.affiliation: Department of Radiology, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ritter
authors.affiliation: Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany eric.verhoeven@klinikum-nuernberg.de.
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D002445:Celiac Artery / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging; D016879:Salvage Therapy; D015607:Stents; D016896:Treatment Outcome
keywords: branched stent-graft; complications; fenestrated stent-graft; juxtarenal aortic aneurysm; retrograde catheterization; thoracoabdominal aneurysm