Laparoscopic hybrid techniques for ectopic or accessory renal arteries debranching in complex endovascular aneurysm...

The aim of this study was to report an assisted or totally laparoscopic approach for renal revascularization in patients with congenital renal vascular anomalies during endovascular abdominal aneurysm repair (EVAR). In three patients with an ectopic main or a large accessory renal artery (>3mm) arising from the aneurysm, laparoscopic exposure of the target renal artery and the ipsilateral iliac bifurcation was performed. In two patients a small incision was made over the area between the iliac bifurcation and the renal target vessel in order to facilitate the anastomotic procedure. In the third patient a totally laparoscopic bypass between a big left inferior renal polar artery and the left common femoral artery was carried out. In all patients the aneurysm was successfully excluded using an endovascular graft. Technical success was achieved in all three patients. The mean total operative time was 126 min (range 110-152 min). The mean hospital length of stay (HLS) was 3.5 days. Renal function of the patients remained unchanged. All bypasses were found to be patent and endoleaks was not observed at 6-month follow-up. Laparoscopic assisted or totally laparoscopic renal revascularization may increase the applicability of EVAR in complex abdominal aortic aneurysms.