Laser Fenestration of Renal Artery in Fenestrated Endograft Repair of Abdominal Aortic Aneurysm
Rteil A, Bendix S, Nypaver TJ, Weaver MR, and Kabbani LS. Laser Fenestration of Renal Artery in Fenestrated Endograft Repair of Abdominal Aortic Aneurysm. Journal of the American College of Surgeons 2020; 231(4):S346-S347.
Journal of American College of Surgeons
Introduction: Fenestrated endografts have expanded the indication for endovascular abdominal aortic repair. We present a case of an abdominal aortic aneurysm (AAA) repair with fenestrated endograft (FEVAR) with in situ laser fenestration of the right renal artery.
Methods: This is the case of a 72-year-old man who was referred for evaluation of a 5.8 cm abdominal aortic aneurysm.
Results: Due to the proximity of the right renal artery and superior mesenteric artery (SMA) ostia, a prefabricated fenestrated endograft could not be manufactured. We therefore requested a fenestrated graft with an SMA scallop, a left renal fenestration, and no right renal fenestration. Access to the right renal artery was obtained through the left brachial approach and an uncovered S.M.A.R.T. (Cordis Corporation) was deployed to mark the origin of the right renal artery (Fig. B). A fenestrated endograft (Cook Medical) with a left renal fenestration and an SMA scallop was then deployed (Fig. C). Using the S.M.A.R.T. stent as a target, a fenestration was created using an endovascular laser (Philips Medical) (Fig. D). An iCAST covered stent (Atrium Medical) was then deployed through the new fenestration, and fully expanded using a high-pressure balloon (Fig. E). Another iCAST stent was deployed into the left renal artery. Completion angiogram illustrated patent renal arteries without endoleaks (Fig. F). Postoperative course was uncomplicated, and the patient was discharged on postoperative day 2.
Conclusion: Some aortic pathologies still pose unique challenges to advanced endovascular modalities. FEVAR with in-situ laser fenestration is a feasible option for patients with unfavorable anatomy.