Preemptive coil occlusion of major aberrant renal artery to allow endovascular repair of abdominal aortic aneurysm with crossed fused renal ectopia.

BACKGROUND

Crossed fused renal ectopia and other similar renal anomalies are nearly always associated with major renal arterial, venous, and collecting system anomalies. These complicate both open repair and endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). We present a case of successful EVAR of an AAA with crossed fused renal ectopia.

PATIENT DESCRIPTION: A 76-year-old man was followed with an AAA and was also noted to have crossed fused renal ectopia. The aneurysm increased in diameter to 5.5 cm, and repair was recommended. Anatomy appeared challenging for open repair but also for EVAR because of a highly angulated neck and the major renal artery to the ectopic segment originating from the upper part of the aneurysm. However, EVAR appeared feasible if this renal artery could be sacrificed. Coil embolization of this renal artery was performed before EVAR. The patient's renal function was stable, and he suffered only a few days of abdominal pain. EVAR was performed 25 days later and required adjunctive procedures to eliminate a type 1 endoleak as had been feared because of the highly angulated neck. The patient suffered no decline in renal function and remained well 6 months later with no evidence for endoleak or other complication.

COMMENT: Renal anomalies present major challenges in aortic aneurysm repair. Preemptive sacrifice of a portion of the renal mass may allow successful repair without apparent deleterious effects.