Physician modification of a Gore endograft for accessory renal artery preservation

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Nephrology

Background:

• Accessory renal arteries in the proximal seal zone complicate endovascular repair of infrarenal abdominal aortic aneurysms.
• Patients with chronic kidney disease are at higher risk for renal dysfunction during open repair.

Purpose of the Study:

• To describe the successful endovascular repair of an infrarenal abdominal aortic aneurysm in a patient with accessory renal arteries and chronic kidney disease.
• To present a novel technique using a physician-modified endograft with fenestrations.

Main Methods:

• Case report of a 76-year-old male with diabetes, hypertension, CAD, and stage 3a chronic kidney disease.
• Infrarenal abdominal aortic aneurysm (5.5 cm) with accessory renal arteries in the seal zone.
• Endovascular aneurysm repair using a physician-modified endograft with punch biopsy-created fenestrations.

Main Results:

• The endovascular repair was technically successful.
• No type I or III endoleak was observed post-procedure.
• Estimated glomerular filtration rate remained stable at 2-month follow-up, indicating preserved renal function.

Conclusions:

• Physician-modified endografts with fenestrations are a viable option for treating complex abdominal aortic aneurysms with accessory renal arteries.
• This approach can be safe and effective in patients with chronic kidney disease, preserving renal function.