Renal Artery Stent-Graft Implantation Using the Retrograde Approach in a Patient Who Developed a Renal Artery Aneurysm after Thoracoabdominal Aortic Repair

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INTRODUCTION: Herein, we report a patient who underwent stent-graft implantation using the retrograde approach for a renal artery aneurysm.

CASE PRESENTATION: The patient was a 48-year-old man who underwent total arch replacement, thoracoabdominal aortic repair, aortic root replacement, and thoracic endovascular aortic repair for Marfan syndrome. A right renal artery aneurysm developed at the prosthetic graft anastomosis during observation. First, stent-graft implantation using the antegrade approach was performed. However, the delivery system could not be advanced to the right renal artery because of prosthetic graft kinking. Therefore, the procedure was discontinued. Next, the retrograde approach was used. A right hypochondral oblique incision was made. The right renal artery was exposed with the retroperitoneal approach, and a stent graft was retrogradely inserted into the renal artery and deployed between the prosthetic graft and the distal right renal artery to cover the aneurysm. The patient was followed up for 3 years after the surgery, and he did not develop any aneurysm.

CONCLUSIONS: Renal artery stent graft implantation using the retrograde approach can be a treatment option for renal artery aneurysms in patients with a hostile abdomen.