Renal Revascularization With X-Crossing Technique During Complex Aortic Aneurysm Repair Using Branched Endograft

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Thoracoabdominal (TAAA) and pararenal aortic aneurysms (PAA) present complex endovascular repair challenges.
• Hostile renal artery anatomy can impede successful branched endovascular aneurysm repair (BEVAR).

Purpose of the Study:

• To describe the renal branches x-crossing technique for TAAA and PAA repair.
• To evaluate its utility with off-the-shelf T-Branch endografts in challenging renal artery configurations.

Main Methods:

• A case report of a 72-year-old woman with a symptomatic TAAA and complex renal anatomy.
• Implementation of the renal branches x-crossing technique with a T-Branch endograft.
• Utilized axillary access and self-expandable stent grafts for improved renal artery accommodation.

Main Results:

• Successful cannulation of upward-takeoff renal arteries was achieved by crossing the renal branches.
• The technique facilitated endovascular treatment in a patient with otherwise impossible renal artery access.
• Off-the-shelf T-Branch endograft integration was demonstrated.

Conclusions:

• The renal branches x-crossing technique is a feasible strategy for complex endovascular aortic repair.
• This method enhances the ability to cannulate challenging renal arteries in hostile aortic anatomies.
• It improves treatment options for patients with TAAA and PAA requiring BEVAR.