title: Translumbar Puncture for Retrograde Catheterization of a Kinked Left Renal Stent After Fenestrated Endograft Repair.
abstract: To describe a case of percutaneous retrograde left renal artery cannulation and restenting for severe distortion of a bridging stent diagnosed at the time of fenestrated endovascular aneurysm repair (FEVAR).
  
  
  
  A 79-year-old man underwent 4-vessel FEVAR, during which completion angiography showed a good postoperative result, but cone beam computed tomography (CBCT) demonstrated severe distortion of the proximal part of the left renal stent. An antegrade or hybrid approach to recannulate the vessel was not possible due to the stent architecture and patient comorbidities. Contrast-enhanced CBCT was used to define the needle trajectory for a percutaneous translumbar approach. Fusion imaging software registered the planned needle track to the live fluoroscopy image. Respiratory motion compensation was used. Retrograde cannulation of the left renal artery was achieved; via a through-and-through wire with the left femoral artery, the left renal artery stent was relined using a covered stent. No deterioration of renal function was observed following the procedure. Contrast-enhanced duplex ultrasound demonstrated good flow in all target vessels without endoleak.
  
  
  
  Translumbar puncture and retrograde catheterization of a severely distorted left renal artery stent is possible during FEVAR using advanced imaging applications and can prevent target vessel loss.
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Hertault
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Clough
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France.
authors.forename: Teresa
authors.initials: T
authors.lastname: Martin-Gonzalez
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France.
authors.forename: Rafaelle
authors.initials: R
authors.lastname: Spear
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Azzaoui
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sobocinski
authors.affiliation: Aortic Center, Vascular Surgery Department, Heart and Lung Institute, University Hospital of Lille, France stephan.haulon@chru-lille.fr.
authors.forename: Stéphan
authors.initials: S
authors.lastname: Haulon
mesh_terms: D000368:Aged; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002404:Catheterization; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011677:Punctures; D012077:Renal Artery; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: bridging stent; endovascular aneurysm repair; fenestrated stent-graft; fusion imaging; renal artery; retrograde approach; salvage maneuver; target lesion revascularization