Abstract We0020: Transrenal Percutaneous Canalization of the Renal Artery: A Challenging Endovascular Procedure in the Context of a Complex Abdominal Aortic Aneurysm.

We present a case of a 60-year-old patient admitted to our service with an incidental finding of a juxtarenal abdominal aortic aneurysm with challenging anatomy due to the angle of the neck and the visceral branches compromised by the aneurysmal sac. The highlight of this case is the successful correction of the aneurysm in two surgical stages, including the percutaneous transrenal cannulation of the left renal artery with the endoprosthesis. Our hypothesis is to demonstrate that this technique is innovative and can be a viable option for similar cases to preserve renal flow. Results: In the first stage, a T-Branch branched endoprosthesis was implanted for all visceral branches, except the left renal artery. Peripheral balloon angioplasty was performed to improve the opening of this branch. Twenty days later, a second surgical stage was performed, where the left renal artery was selectively catheterized in a percutaneous transrenal manner. Under fluoroscopic guidance, the catheter was advanced to the abdominal aorta near the right brachial access site. A snare was passed from the abdominal endoprosthesis, capturing the percutaneous guidewire, and with the through-and-through maneuver, a covered stent was deployed from the mid-left renal artery to the left renal branch of the endoprosthesis. The patient had an uneventful postoperative course and was discharged with a small left renal hematoma that did not require additional management. Conclusion: In conclusion, while there are reports in the literature, regarding the safety of stent-graft fixation and its effects on renal function, concluding that it is safe in the short term, there is no mention of similar cases to the one presented, where the percutaneous approach was used, demonstrating our hypothesis that it is a variant of the technique that could be equally effective in cases where cannulation of the renal arteries from the endoprosthesis is not possible.