Repair of a type II thoracoabdominal aortic aneurysm with three equal-sized renal arteries and bilateral common iliac aneurysms using a completely percutaneous transfemoral approach

Over the past two decades, fenestrated/branched endovascular aneurysm repair has been increasingly performed with high technical success rates and low mortality and morbidity for thoracoabdominal aortic aneurysms (TAAAs). 1 This has been shown to have similar outcomes for both post-dissection and degenerative TAAAs. 2 Postoperative acute kidney injury is associated with decreased postoperative survival. 3Prior studies using volumetric kidney perfusion have shown that >40% of one kidney and >25% of two kidneys perfused by a renal artery merit consideration of renal artery preservation during fenestrated/branched endovascular aneurysm repair. 4This would decrease the chance of postoperative acute kidney injury and associated mortality.A 73-year-old man presented with 6.2 cm type II TAAA secondary to chronic dissection, with three equal-sized renal arteries and bilateral common iliac aneurysms.He had a prior history of ascending aortic replacement for acute dissection.He developed chronic heart failure due to non-ischemic cardiomyopathy.At the time of presentation, he had depressed ejection fraction (35%-40%) with bilateral atrial dilation and dyspnea on exertion, making open thoracoabdominal repair prohibitive.His baseline creatinine was 1.25 mg/dl, and estimated glomular filtration rate 56.5 ml/min/1.73m 2 .He consented to the publication of this case.Computed tomography angiogram demonstrated an intact prior ascending aortic repair, a three-vessel aortic arch, and a visceral aorta with patent celiac, superior mesenteric artery (SMA), right renal, and two equalsized left renal arteries, with aneurysmal degeneration from zones 3 to 11.Both left renal arteries measured 6 mm in diameter and appeared to perfuse significant portions of the kidney.