Bracale Umberto Marcello, Giribono Anna Maria, Vitale Gaetano, Narese Donatella, Santini Gianpaolo, Del Guercio Luca
Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
Department of Diagnostic Imaging, Section of General and Emergency Radiology, Cardarelli Hospital of Naples, 80131 Naples, Italy.
Case Rep Vasc Med. 2014;2014:710742. doi: 10.1155/2014/710742. Epub 2014 Dec 3.
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.
本文旨在报告在肾下腹主动脉瘤（AAA）的血管内动脉瘤修复术（EVAR）期间，对双侧肾动脉意外覆盖的一种挽救策略。一名72岁患有6厘米肾下腹主动脉瘤的女性接受了标准分叉移植物的血管内治疗。完成血管造影后，发现双侧肾动脉均被意外闭塞。通过左经皮肱动脉入路，对右肾动脉进行了插管并植入了烟囱支架；然而，左肾动脉无法进行此操作。因此，采用了腹膜后手术入路，植入逆行烟囱支架以恢复血流。三个月后，双侧肾动脉通畅，肾功能与基线无差异。经肱动脉经皮入路的血管内方法以及逆行插管的开放腹膜后入路，都是在EVAR期间使意外闭塞的肾动脉再通的可行挽救技术。
