How to do it - Endovascular solutions for the renovisceral segment in coral reef aortas

Background: Coral reef atherosclerosis of the renovisceral aorta leads to end-organ and extremity malperfusion due to ischaemia and/or embolic events. Those mostly female patients typically present with renovascular hypertension, chronic mesenteric ischaemia, and symmetric peripheral artery disease of all stages, including critical limb ischaemia. Mortality and morbidity are high in open surgery. Materials and methods: Here we describe step by step the individually designed endovascular solutions with multiple arterial accesses using stentgrafts and open stents in 8 consecutive patients. Results: All patients survived, acute renal failure occurred in 1 case, otherwise uneventful inhospital courses. Patients were followed over 25 (7-56) months with durable results. Conclusions: Endovascular treatment of coral reef aorta leading to aortic stenosis or occlusion in the renovisceral segment is feasible in most cases using multiple arterial accesses with good functional results, low mortality and morbidity and durable results.