Stents in renal artery bifurcation stenosis: a case report

An Original Bailout Solution for Renal Artery Dissection after Fenestrated/Branched EVAR

BACKGROUND

Renal artery (RA) dissection may occur during endovascular treatment of thoracoabdominal aneurysms. The aim of this paper is to report the use of kissing coronary stents in the renal bifurcation as a bailout solution for dissection after fenestraded/branched endovascular aortic repair (F/B-EVAR).

METHODS/RESULTS

A 73-year-old male with an asymptomatic Crawford type 4 thoracoabdominal aneurysm and a concomitant right common iliac artery aneurysm was proposed for endovascular repair, consisting of thoracic endovascular aortic repair plus custom-made device F/B-EVAR, followed by staged bifurcated EVAR plus right-sided IBD. In the control angiogram of the first procedure, a distal occlusion of the left renal artery was observed and attributed to iatrogenic dissection. The 6F sheath was reintroduced and the two main branches of the RA were catheterized with 0.014 wires. Then, two coronary drug-eluting stents were used for a kissing stenting technique with good angiographic and clinical results. As planned, one week later the patient underwent an uneventful second stage procedure. Follow-up CTA at 1 year showed normal patency of the renal stents as well as aneurysm shrinking and no signs of endoleak.

CONCLUSIONS

In the reported case, the use of coronary stents was a safe and long-lasting solution to rescue an iatrogenic renal artery dissection during F/B-EVAR.

Kissing stenting of aorto-ostial lesions in juxtaposed renal arteries

Percutaneous angioplasty with or without stenting has become an established procedure for treatment of renal artery stenosis for control of hypertension or progressive renal dysfunction. Anatomic variation of renal arteries is common with dual blood supply of unilateral kidney noted in almost 25% of the general population. Renal angioplasty of these anatomic variants of renal arteries is challenging. We present an unusual case of juxtaposed renal arteries with aorto-ostial lesion where direct kissing stenting was done with excellent technical and clinical outcome.