Abstract
We report a case of renal artery stenting with a new catheter access technique for severe stenosis of the renal artery caused by endovascular aneurysm repair (EVAR). An 82-year-old man who had an abdominal aortic aneurysm with a short and reverse-tapered proximal neck was received EVAR with a Zenith Flex stentgraft. We confirmed bilateral renal artery angiogram before finishing the operation. The patient status indicated poor postoperative urinary output and increasing serum BUN and Cr. Duplex scan revealed bilateral renal artery stenosis. We decided to salvage the bilateral renal arteries by stenting. In the first attempt, we inserted a delivery catheter by a brachial approach and were able to place a stent on the right renal artery, but we could not put stent into the left renal artery, because of the catheter could not be pushed through the severe stenosis of the left renal artery orifice. On our second attempt, we tried to insert Amplatz gooseneck snare catheter by a femoral approach in order to pinch the top part of the delivery catheter by a brachial approach, then the delivery catheter was able to be pulled through into the left renal artery orifice with additional traction by the snare catheter. Finally, we succeeded in placing the stent in the left renal artery.
