Preservation of the accessory renal arteries after endovascular repair of common iliac artery aneurysm using kissing stent grafts

Accessory renal arteries involved in atherosclerotic occlusive disease at the aortic bifurcation

Accessory renal arteries (ARAs) are embryonic remnants found in more than one-third of patients and occurring bilaterally in 10% of the population. Very few reports have documented such vessels arising near or at the level of the aortic bifurcation. Furthermore, the presence of ARAs has yet to be described in the context of atherosclerotic disease. Here, we present a unique case of large bilateral ARAs originating above the aortic bifurcation concurrent with symptomatic aortoiliac atherosclerotic disease. We highlight the embryologic and clinical significance of these vessels as well as discuss their potential role in accelerating atherosclerotic disease processes.

Parallel Covered Stents Technique in the Treatment of Abdominal Aortic Diseases

PURPOSE

To investigate the safety and efficacy of the parallel covered stents technique in the treatment of anatomically challenging aortic aneurysms, pseudoaneurysms, and dissections.

MATERIALS AND METHODS

Data were retrospectively collected from 16 patients with abdominal aortic diseases who were treated with parallel covered stents (Gore Excluder, n = 14; Medtronic Endurant, n = 2) between January 2016 and July 2018. Patients were treated with this technique if they were unsuitable for either open repair or standard endovascular aortic repair with bifurcated stents. Such unfavorable anatomy included narrow aortic necks (≤18 mm), small vascular access (occluded or ≤6.0 mm), or compressed aortic lumens (≤18 mm). All patients were male, with a mean age of 64.7 ± 13.3 years. For true aneurysms (n = 4) and pseudoaneurysms (n = 4), the mean diameter and length of the proximal necks were 17.5 ± 2.6 mm (range, 14-21 mm) and 51.0 ± 12.5 mm (range, 39-75 mm), respectively. The minimal diameter of true lumen in cases with aortic dissection and penetrating ulcers (n = 8) was 14.8 ± 3.1 mm. Small or occluded femoral access was found in 3 patients.

RESULTS

Technical success was 100%. Minor type I endoleaks, which were seen on completion angiography in 5 patients, had all resolved within 3 months. There were no perioperative deaths. Postoperative complications included supraventricular tachycardia in 1 patient and pneumonia combined with heart failure in 1 patient. Patency of all stents was observed at a mean follow-up of 21.8 ± 10.1 months.

CONCLUSIONS

The parallel covered stents technique appears to offer a feasible solution for abdominal aortic diseases with unfavorable anatomy. Long-term follow-up is needed to further evaluate the safety and efficacy of this technique.