Hybrid Endovascular Aortic Repair in a Post-Renal Transplant Patient With Juxtarenal Abdominal Aortic Aneurysm

J INVASIVE CARDIOL 2022;34(10):E753-E754.

Key words: endovascular aortic repair, abdominal aortic aneurysm, kidney transplantation

A 45-year-old man presented with pain in the abdomen and pulsatile abdominal swelling of 3-month duration. He had kidney transplantation for chronic kidney disease 2 years prior. Computed tomography (CT) angiography revealed a 10.0-cm x 6.5-cm juxtarenal, fusiform abdominal aortic aneurysm (AAA), extending from the origin of the superior mesenteric artery (SMA) to the aortic bifurcation. A hybrid aortic intervention was planned. A polytetrafluoroethylene (PTFE) bypass graft was anastomosed from the left external iliac artery to the SMA. A contrast aortogram confirmed the CT angiography finding (ie, AAA extending from the origin of SMA to aortic bifurcation) (Figure 1A and Figure 1B), normal transplanted renal artery (Figure 1C), and patent bypass graft to SMA. A bifurcation stent graft (Gore Excluder AAA endoprosthesis) was implanted. The main body 31-mm x 14.5-mm x 170-mm size was implanted below the origin of the celiac trunk, extending up to the left common iliac artery. The side branch 14.5-mm x 120-mm size was implanted from the right side, covering the right common iliac artery (Figure 1D and Video Series). A repeat CT angiogram at 1-year follow-up showed patent bifurcation stent graft and SMA bypass graft, and normal transplanted renal artery (Figure 1E and Figure 1F). A recent CT angiography at 11 years of asymptomatic follow-up revealed a patent stent graft without any endoleak and patent transplanted renal artery (Figure 1G and Figure 1H). The PTFE bypass graft to SMA was occluded. There were adequate collaterals from the celiac trunk (gastroduodenal and pancreaticoduodenal arcade) to the proximally occluded SMA (Figure 1G and Figure 1H).

The index case demonstrated the favorable long-term outcome of endovascular aortic repair for juxtarenal AAA in a post-renal transplant patient.

Affiliations and Disclosures

From the ¹Department of Cardiology; ²Renal Transplant Surgery and Radio-diagnosis; ³Post Graduate Institute of Medical Education & Research, Chandigarh, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 25, 2022.

Address for correspondence: Prof (Dr) Rajesh Vijayvergiya, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh – 160 012 India. Email rajeshvijay999@hotmail.com

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