Delayed Hepato-Spleno-Renal Bypass for Renal Salvage Following Malposition of an Infrarenal Aortic Stent-Graft

Abstract

Bilateral renal artery occlusion caused by malposition of a stent-graft is probably underreported. If revascularization of the kidneys by endovascular techniques fails, there is no consensus as to the optimal approach. Delayed revascularization should be considered if the kidneys show concentration of imaging contrast. Hepato-spleno-renal bypass, which has not heretofore been indicated for renal salvage post EVAR, can provide a good functional result in this situation.

Successful Hybrid Treatment of Stent-Graft Migration Caused by Type B Aortic Dissection after Endovascular Aortic Aneurysm Repair: A Case Report

“…According to the literature, a hepato-spleno-renal bypass has been used to salvage unintentionally occluded renal arteries after EVAR. 9 , 10 ) We modified this procedure to facilitate EVAR for the juxtarenal aortic aneurysm. We used the aorta below the origin of the SMA as the proximal landing zone of the stent-graft.…”

Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass

“…Renal artery occlusion is a rare complication of EVAR with a reported incidence of 0.1% to 3.5%. 3 , 4 , 5 , 6 However, the incidence may be under-reported, with as many as 40% of surveyed UK surgeons experiencing bilateral renal occlusion during EVAR. 3 Malposition of the stent graft occurs at varied frequency, ranging from 2% to 13.2% of cases, 7 , 8 , 9 usually identified at completion angiography.…”

“…The splenic artery is readily accessible and was therefore the conduit of choice for the left renal artery inflow. For the right renal revascularization, the hepatic artery is commonly used 3 ; however, it requires extensive dissection. We opted to revascularize the right renal from the splenorenal conduit to decrease operative and renal ischemia time.…”

Postoperative “Chimney” for Unintentional Renal Artery Occlusion after EVAR

“…Our case shows that urgent revascularization could be effective for this type of complication. Maybe the favorable outcome was facilitated by the early development of a rich collateral circulation that has been studied to come up most commonly from the periureteral, peripelvic, and adrenal vessels and that can maintain viability of nephrons at sub-filtration arterial pressures; furthermore, it provides the rationale for rescue intervention after total renal artery occlusion, even when the diagnosis has been delayed [ 16 , 17 ].…”