Adiarto Suko, Kalaij Ayers Gilberth Ivano, Indriani Suci
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia-National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Catheter Cardiovasc Interv. 2025 Aug;106(2):811-815. doi: 10.1002/ccd.31614. Epub 2025 May 21.
Although endovascular aortic repair (EVAR) has been widely used in abdominal aortic aneurysm (AAA), significant proportion are still considered unsuitable anatomically, especially in short neck anatomies. Endoanchors has been reported to be successfully treat challenging AAA with short neck; however, in such case, renal artery can be accidentally occluded by the graft, potentially leading to renal ischemia and necrosis. Emergency renal stenting has been shown to be safe and effective to salvage the kidney, however none of this procedure has been reported after the use of endoanchors.
In this case, we presented a 69-year-old hypertensive male with AAA which went through successful emergency trans-femoral renal stenting after accidental right renal artery occlusion following EVAR with endoanchors for AAA with short angulated neck.
We presented a case report of a 69-year-old hypertensive male with an infrarenal abdominal aortic aneurysm and challenging short, angulated neck anatomy, treated with EVAR using EndoAnchors for graft fixation. Following the procedure, the patient developed an acute right renal artery occlusion. Clinical data, imaging findings, procedural details, and outcomes were retrospectively collected and analyzed. Emergency revascularization was performed via a trans-femoral approach, utilizing advanced endovascular techniques and devices typically reserved for complex interventions. Key factors contributing to successful revascularization of an occluded right renal artery after EVAR with an endoanchors were success included the availability of a steerable guiding catheter, allowing for near 320-degree manipulation for optimal co-axial orientation to the renal artery, providing better device support. Despite initial difficulty with wire insertion, a micro-catheter was used to facilitate renal artery wiring. After pre-dilatation, a Guidezilla guide extension was utilized to deliver the stent smoothly, overcoming resistance from the graft and anchors, a technique often used in complex coronary interventions.
Accidental right renal artery occlusion following EVAR with endo-anchors could be successfully treated with renal stenting. Renal artery stenting remained possible despite strong attachment of the graft with the aortic wall after Endo-anchors implantation.
尽管血管腔内主动脉修复术（EVAR）已广泛应用于腹主动脉瘤（AAA）的治疗，但仍有相当一部分患者在解剖结构上被认为不适合该手术，尤其是在颈部较短的解剖结构中。据报道，EndoAnchors可成功治疗颈部较短的具有挑战性的AAA；然而，在这种情况下，移植血管可能会意外阻塞肾动脉，潜在地导致肾缺血和坏死。紧急肾动脉支架置入术已被证明对挽救肾脏是安全有效的，然而在使用EndoAnchors后尚未有该手术的相关报道。
在此病例中，我们报告了一名69岁的高血压男性患者，其患有AAA，在使用EndoAnchors对短而呈角状颈部的AAA进行EVAR术后意外发生右肾动脉阻塞，随后成功进行了经股动脉紧急肾动脉支架置入术。
我们报告了一例69岁高血压男性患者的病例，该患者患有肾下型腹主动脉瘤且颈部短而呈角状，解剖结构具有挑战性，采用EndoAnchors进行移植血管固定的EVAR治疗。术后，患者出现急性右肾动脉阻塞。回顾性收集并分析临床数据、影像学检查结果、手术细节及治疗结果。通过经股动脉途径进行紧急血运重建，采用通常用于复杂介入治疗的先进血管腔内技术和器械。在使用EndoAnchors进行EVAR术后，成功实现阻塞右肾动脉血运重建的关键因素包括：有可操控的引导导管，可进行近320度的操作以实现与肾动脉的最佳同轴定位，提供更好的器械支撑。尽管最初钢丝插入困难，但使用了微导管以方便肾动脉穿线。预扩张后，使用Guidezilla引导延长器顺利输送支架，克服了来自移植血管和锚定装置的阻力，这是复杂冠状动脉介入治疗中常用的技术。
EndoAnchors辅助EVAR术后意外发生的右肾动脉阻塞可通过肾动脉支架置入术成功治疗。尽管在植入EndoAnchors后移植血管与主动脉壁紧密附着，但肾动脉支架置入术仍可行。
