Emergency Trans-Femoral Stenting After Accidental Right Renal Artery Occlusion Following Endovascular Aortic Repair With Endoanchors for Abdominal Aortic Aneurysm With Short Angulated Neck.

Background: 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.

Aims: 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.

Methods and results: 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.

Conclusion: 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.