Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula ligation after renal transplantation is uncommon. Herein, we describe the case of a 64-year-old man who developed a giant symptomatic BAA 21 years after ligation of the fistula. He was submitted to surgical excision of the aneurysm followed by interposition prosthetic graft.
R enal artery aneurysms (RAAs) are relatively rare with an estimated incidence of 0.1% in the general population, rupture incidence of about 30%, and a consequent death rate of 80% (1). The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy (29%), mortality (1.6%), and morbidity (12%). Nowadays, an endovascular approach such as coil embolization or stent-graft with coil embolization is an alternative in the treatment of narrow neck RAAs; however, when facing complex wide-necked aneurysms or complex aneurysm bifurcation, a surgical aneurysmectomy may be required. Recently, stent-assisted coil embolization with preservation of renal blood flow, has become a realistic alternative to surgery in wide-necked, saccular or extraparenchymal aneurysms.The aim of this study is to report our experience in the treatment of wide-necked complex RAAs through the stent-assisted detachable coil embolization technique in three patients. One case required a stent-assisted coil embolization with waffle-cone technique due to a wide-necked bifurcation RAA. TechniqueLaboratory investigations including complete blood count, renal and liver function tests, electrocardiography, chest radiography, and ultrasonographic evaluation of the carotid artery, abdominal aorta, and visceral arteries were carried out prior to the procedures. All aneurysms were treated under local anesthesia using a transfemoral approach. After positioning the femoral sheath, an intravenous bolus of 5000 IU of heparin was dispensed. Stent-assisted coil embolization was performed using the Solitaire AB stent nitinol self-expandable electrolytic detachment (Covidien-EV3) and Concerto Axium coils controlled release system (Covidien-EV3). Because of its featured trait of a closed-cell stent with high radial force, Solitaire AB stent does not permit the coils' prolapse and migration, preserving a good blood flow. On the other hand, detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different size aneurysms. After the procedure, the patients were monitored for 48 hours and were discharged with the administration of double antiplatelet therapy, which included acetylsalicylic acid (100 mg daily) and clopidogrel (75 mg daily) for six months. After six months, clopidogrel treatment was interrupted and only acetylsalicylic acid (100 mg daily) was maintained. Case 1A 64-year-old man was admitted to the outpatient clinic for evaluation of a left saccular RAA, diagnosed on CT-scan during routine follow-up of left hemicolectomy for colorectal I N T E R V E N T I O N A L R A D I O LO G Y T E C H N I C A L N OT E ABSTRACTRenal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for...
Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59 mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass. A 10 mm Dacron graft was used as a main graft bypass and an 11 mm/10 cm stentgraft as endograft connector. Following the respective tunnel of the Dacron graft, an end-to-side proximal anastomosis was performed at distal femoral artery. The aneurysm exclusion was obtained through a proximal and a distal ligation. Postoperative duplex showed adequate bypass patency. Knee x-rays demonstrated no signs of stent kinking/fractures. The postoperative course was uneventful and the patient was discharged home on fourth day post operative. The six-month computed tomography scan and the 12-month duplex control showed a patent bypass with no signs of stenosis.
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.
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