When the chimney is blocked: malignant renovascular hypertension after endovascular repair of abdominal aortic aneurysm

BMC Nephrology

Gil Chernin²  Idit F Schwartz¹  Haggai Sharon¹  Galia Rosen⁴  Yehuda G Wolf³  Amir Gal-Oz¹ 

[1] Department of Nephrology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;Nephrology Department, Tel- Aviv Sourasky Medical Center, 6, Weizmann Street, Tel-Aviv 64239, Israel;Department of Vascular Surgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;Department of Radiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

关键词: Renovascular hypertension;    Endovascular Aneurysm Repair (EVAR);    Chimney graft (CG);    Abdominal aortic aneurysm (AAA);   

Others  :  1082968
DOI  :  10.1186/1471-2369-14-71

 received in 2012-11-18, accepted in 2013-03-12,  发布年份 2013

【 摘 要 】

Background

The Chimney graft (CG) procedure is one of the novel modification techniques of the endovascular aneurysm repair (EVAR) surgery to treat suprarenal and juxtarenal abdominal aortic aneurysms. Other indications for the use of CG placement include thoracic and thoracoabdominal aneurysms with supraortic branches orifice involvement and cases of common iliac artery aneurysms with or without internal iliac artery involvement. The technique is used in patients who due to aortic-neck morphology and lack of adequate fixation and/or sealing zones are not eligible for standard EVAR. In this procedure, a parallel stent-graft is placed adjacent to the main body of the aortic endograft to maintain blood supply to renovisceral or supraortic branches, once the body of the aortic stent-graft is deployed. Symptomatic occlusions of the CG with novel renovascular hypertension were not described until now.

Case presentation

A-64-year-old male patient, presented with new-onset malignant hypertension, 13 months after an EVAR operation with CG placement to the left renal artery. The patient was on preventive clopidrogel therapy, which was withheld temporarily for several days, one month before presentation. Imaging studies revealed a novel form of iatrogenic renovascular hypertension, caused by occlusion of the CG. Any attempt to recanalize the covered stent or revascularize the left kidney was rejected and conservative treatment was chosen. Seven months after presentation, blood pressure was within normal ranges with little need for antihypertensive therapy.

Conclusions

Physicians should be aware that the novel emerging techniques of EVAR to overcome the limitations of the aortic-neck anatomy may still adversely influence the renal outcome with potential development of new-onset hypertension.

【 授权许可】

   
2013 Gal-Oz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lee JT, Greenberg JI, Dalman RL: Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 2012, 55:935-946.
• [2]Ohrlander T, Sonesson B, Ivancev K, Resch T, Dias N, Malina M: The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther 2008, 15:427-432.
• [3]Beck AW, Goodney PP, Nolan BW, Likosky DS, Eldrup-Jorgensen J, Cronenwett JL: Vascular Study. Predicting 1-year mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 2009, 49:838-843.
• [4]Muhs BE, Verhoeven EL, Zeebregts CJ, Tielliu IF, Prins TR, Verhagen HJ, van den Dungen JJ: Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts. J Vasc Surg 2006, 44:9-15.
• [5]Ricco JB: Fenestrated stent grafting for aortic aneurysm in Europe. Eur J Vasc Endovasc Surg 2010, 39:545-546.
• [6]Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, Popa M, Green R, Ouriel K: Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg 2003, 38:990-996.
• [7]Hinchliffe RJ, Thompson MM: Illuminating the fog that surrounds chimney grafts: commentary on: triple-barrel graft as a novel strategy to preserve supra-aortic branches in Arch-TEVAR procedures. Eur J Vasc Endovasc Surg 2012. Nov 11 (Epub ahead of print)
• [8]Melas N, Saratzis A, Dixon H, Saratzis N, Lazaridis J, Perdikides T, Kiskinis D: Isolated common iliac artery aneurysms: a revised classification to assist endovascular repair. J Endovasc Ther 2011, 18:697-715.
• [9]Amiot S, Haulon S, Becquemin JP, Magnan PE, Lermusiaux P, Goueffic Y, Jean-Baptiste E, Cochennec F, Favre JP: Association Universitaire de Recherche en Chirurgie Vasculaire. Fenestrated endovascular grafting: the French multicentre experience. Eur J Vasc Endovasc Surg 2010, 39:537-544.
• [10]Moulakakis KG, Mylonas SN, Avgerinos E, Papapetrou A, Kakisis JD, Brountzos EN, Liapis CD: The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg 2012, 55:1497-1503.
• [11]Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA: Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 2011, 53:895-904.
• [12]Donas KP, Torsello G, Austermann M, Schwindt A, Troisi N, Pitoulias GA: Use of abdominal chimney grafts is feasible and safe: short-term results. J Endovasc Ther 2010, 17:589-593.
• [13]Hiramoto JS, Chang CK, Reilly LM, Schneider DB, Rapp JH, Chuter TA: Outcome of renal stenting for renal artery coverage during endovascular aortic aneurysm repair. J Vasc Surg 2009, 49:1100-1106.
• [14]Hollenberg NK: The treatment of renovascular hypertension: surgery, angioplasty, and medical therapy with converting-enzyme inhibitors. Am J Kidney Dis 1987, 10(Suppl 1):52-60.
• [15]Blum U, Billmann P, Krause T, Gabelmann A, Keller E, Moser E, Langer M: Effect of local low-dose thrombolysis on clinical outcome in acute embolic renal artery occlusion. Radiology 1993, 189:549-554.
• [16]Lanckohr C, Torsello G, Scheld H, Schieffer B, Theilmeier G: Drug-eluting stents and perioperative risk - more than matters of the heart? Vasa 2012, 41:410-418.