Acute Renal Artery Occlusion and Trapped Renal Artery Catheter During Infrarenal AAA Stent Grafting

, Anna Maria Belli², Joo-Young Chun³, Raymond Chung³, Raj Das³, Andrew England⁴, Karen Flood⁵, Marie-France Giroux⁶, Richard G. McWilliams⁷, Robert Morgan³, Nik Papadakos³, Jai V. Patel⁸, Raf Patel⁸, Uday Patel⁹, Lakshmi Ratnam¹⁰, Reddi Prasad Yadavali¹¹ and John Rose¹²

(1)

Department of Interventional Radiology, University Hospitals Southampton, Southampton, Hampshire, UK

(2)

Department of Radiology, St. George’s Hospital and Medical School, Blackshaw Road, London, SW17 0RE, UK

(3)

Department of Radiology, St. George’s Hospital, London, UK

(4)

Department of Radiography, University of Salford, Manchester, UK

(5)

Department of Vascular Radiology, Leeds General Infirmary, Leeds, UK

(6)

Department of Radiology, CHUM-Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

(7)

Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK

(8)

Department of Radiology, The Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK

(9)

Department of Diagnostic Radiology, St. George’s Hospital and Medical School, Blackshaw Road, SW17 0QT London, UK

(10)

Department of Radiology, St. George’s Hospital, Blackshaw Road, SW17 0QT London, UK

(11)

Department of Radiology, Aberdeen Royal Infirmary, Aberdeen, UK

(12)

Department of Interventional Radiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK

Anna Maria Belli

Email: anna.belli@stgeorges.nhs.uk

Raf Patel

Email: rafpatel@gmail.com

Uday Patel

Email: uday.patel@stgeorges.nhs.uk

Lakshmi Ratnam

Email: lakshmi.ratnam@nhs.net

Abstract

This case reviews the management of an occluded renal artery by the fabric of an aortic stent graft during an EVAR procedure.

Keywords

ComplicationsEVARRenal artery occlusionBalloon-expandable stent

Case History

A 75-year-old man was referred with an asymptomatic abdominal aortic aneurysm (AAA). Preoperative CT scanning confirmed a 7.8 cm infrarenal AAA with a short and reversed conical aortic neck (Fig. 19.1a). The patient underwent an elective endovascular repair (EVAR) with implantation of a Zenith bifurcated device (Cook INC, Bloomington, IN). The main body of the Zenith device was deployed from the right common femoral artery. Angiography post-deployment demonstrated fabric coverage of the left renal artery ostium (Fig. 19.1b). Unsuccessful attempts were then made to manually displace the stent graft inferiorly. The reversed taper of the infrarenal neck prevented caudal displacement of the fabric. A decision was made to stent the left renal artery.