CARDIOVASCULAR INTERVENTION IMAGE

Endovascular correction of pararenal abdominal aortic aneurysm using the chimney technique

Frederico Augusto de Carvalho Linhares Filho^I; Antonio Massamitsu Kambara^II; Nilo Mitsuru Izukawa^III; Samuel Martins Moreira^I

^IVascular surgeon. Enhancing surgeon at the Center of Endovascular Interventions of Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil

^IIInterventionist radiologist. Head of the Radiology Section of Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil

^IIIVascular surgeon. Head of the Vascular Surgery Section of Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil

^IVVascular surgeon. Assistant at the Center of Endovascular Interventions of Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil

Male patient, 75 years old, with a history of cramp-like, intermittent abdominal pain, was submitted to CT angiography due to evidence of pararenal abdominal aortic aneurysm. As comorbidity, the patient had chronic obstructive pulmonary disease requiring home oxygen therapy; for this reason, the endovascular treatment was chosen.

The abdominal aneurysm correction was performed using the chimney technique, which consists of the implantation of a coated stent in parallel to the aortic endoprosthesis and allows for continuous perfusion of the renal arteries. This technique permits the endovascular correction of pararenal or juxtarenal abdominal aortic aneurysms.

The procedure was performed through dissection of the bilateral common femoral artery and puncture of the bilateral brachial artery, with the introduction of a long 8F sheath in the abdominal aorta. The renal arteries were catheterized through brachial access and 0.035 extra-stiff guidewires were positioned; then, the 5 × 50 mm Viabahn coated stents (WL Gore & Associates - Flagstaff, USA) were released. The Excluder^® aorta endoprosthesis (WL Gore & Associates, Flagstaff, USA) was positioned through the femoral artery above the anatomical origin of the renal arteries and below the proximal portion of the coated stents (Figure 1).

A CT angiography performed in the postoperative period showed correct coated-stent positioning in the renal arteries, with maintenance of renal perfusion and positioning of the proximal portion of the endoprosthesis above the anatomical origin of the renal arteries, with no evidence of leaks. The blood flow was bilaterally directed to the common iliac arteries, with pre-existing occlusion observed in the right internal iliac artery at its origin (Figures 2 and 3).

CONFLICTS OF INTEREST

The authors declare to have no conflicts of interest.

Received on: 06/07/2013

Accepted on: 08/11/2013

Publication Dates

• Publication in this collection
  06 Nov 2013
• Date of issue
  2013