title: Renal Stent Crushed During Open Aneurysmorrhaphy for Endoleak After Fenestrated EVAR.
abstract: OBJECTIVE
  To report a complication of renal stent crushing during open aneurysmorrhaphy performed 10 years after fenestrated endovascular aneurysm repair (FEVAR).
  
  
  METHODS
  A 67-year-old male patient underwent elective FEVAR of a juxtarenal aortic aneurysm. Uncovered balloon-expandable stents were placed through the fenestrations for the superior mesenteric and right renal arteries; the left renal artery received a Jostent covered balloon-expandable stent. The uncovered right renal stent was noted to be crushed on the first imaging after FEVAR, but was left untreated; the right kidney was thereafter significantly smaller than the left. Over several years, the aneurysm expanded, and type II endoleak involving the lumbar arteries was embolized with coils 7 years after FEVAR. Despite this, the aneurysm continued to enlarge and reached a diameter of 12.8 cm. Open aneurysmorrhaphy and selective ligation of lumbar arteries was performed 10 years after FEVAR. The first surveillance imaging after aneurysmorrhaphy demonstrated a new finding of a crushed left renal stent, which was presumed to be related to surgical instrumentation. The stent was successfully redilated percutaneously, and renal function remained stable. Computed tomography demonstrated a normal appearance of the left renal covered stent after re-expansion. Doppler ultrasound after 7.5 months showed normal renal perfusion.
  
  
  CONCLUSIONS
  Balloon-expandable visceral artery stents are susceptible to crush injury during aortic surgery. Consideration should be given to early imaging after such surgery in FEVAR patients.
authors.affiliation: Radiology Department, Royal Liverpool University Hospital, Liverpool, UK idin@nhs.net.
authors.forename: Islah Ud
authors.initials: IU
authors.lastname: Din
authors.affiliation: Radiology Department, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Usman
authors.initials: U
authors.lastname: Shaikh
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Fisher
authors.affiliation: Radiology Department, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: McWilliams
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D015607:Stents; D013314:Stress, Mechanical; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
keywords: aneurysmorrhaphy; balloon-expandable stent; complication; crushed stent; endovascular aneurysm repair; fenestrated stent-graft; juxtarenal aortic aneurysm; stent deformation