Abstract
A patient was 84-year-old female, presenting mild abdominal pain. Vital signs were normal; however, the enhanced computed tomography showed juxtarenal aortic aneurysm (JAA) measured 80 mm. Because the size was huge, and the patient had mild symptoms, emergency operation was performed. The endovascular treatment was attempted due to her age and some medical histories. The right renal artery was managed with snorkel technique, and the left renal artery with endowedge technique to achieve additional sealing zone and to maintain the distal perfusion. Complete angiography showed patent bilateral renal arteries without endoleaks or enhancement of aneurysm. Postoperative computed tomography showed the patent of stent graft, bilateral renal arteries, and there was no endoleaks. Endovascular aneurysm repair (EVAR) has gained widespread acceptance as the procedure for patients with elective infrarenal abdominal aortic aneurysms. However, the management of JAA with EVAR remains challenging. These techniques, including endowedge and snorkel, achieve additional proximal aortic seal, and may allow for safe and effective endovascular treatment of aneurysms with proximal short aortic necks.
