Prolonged renal artery occlusion after endovascular aneurysm repair: endovascular rescue and renal function salvage

Albeit uncommon, delayed renal dysfunction after endovascular abdominal aortic aneurysm repair (EVAR) can be attributed to proximal stent graft migration or unrecognized partial renal artery coverage. We report two patients who were found to have renal artery occlusion 1 week after EVAR with Zenith (Cook, Bloomington, Ind) infrarenal devices despite patent bilateral renal arteries shown on completion angiograms. Both patients presented with prolonged symptoms of acute renal failure, and uremic encephalopathy developed in one. Both patients were successfully treated with renal artery stenting, which led to symptom resolution and recovery of renal function. Our cases highlight that although postoperative renal occlusion after EVAR is rare, a high index of suspicion and urgent intervention are warranted because renal salvage can be achieved after prolonged ischemic insult.