Delayed endovascular revascularization of renal artery bridging stent occlusion after complex endovascular aortic repair

BACKGROUND AND PURPOSE: Recanalisation of renal artery bridging stent graft thrombosis in patients with delayed ischemia lasting more than 24 h could potentially save some residual renal function. This study evaluates the technical success and short-term clinical outcomes of delayed recanalisation of bilateral or single-functioning kidneys with renal artery occlusion after endovascular repair of complex aortic aneurysms. MATERIALS AND METHODS: We retrospectively analysed 11 patients treated between October 2019 and November 2024 who developed occlusion of a single functioning kidney or bilateral renal stent-graft thrombosis. Technical success was defined as recanalisation of at least one occluded renal bridging stent with restoration of blood flow to the kidney.. Clinical success was, defined by the improvement or stabilisation of residual renal function (eGFR) and delaying the need for dialysis. RESULTS: Delayed endovascular repair was performed for fifteen renal artery stent-graft thromboses in eleven patients.. Mean age was 68.7 ± 5 years; nine patients (81%) were male. Six patients (54%) had contained aortic rupture or aneurysms > 8 cm and were treated acutely/subacutely with off-the-shelf stent grafts; four (36%) received custom-made devices, and one a fenestrated cuff. Main symptoms included anuria (81%), nausea, diarrhoea, and flank pain (100%). Time from symptom onset to treatment ranged 24-96 h (mean 27.2 h), and mean time from index procedure to thrombosis was 10.4 months. Clinical success was achieved in 72% of cases. Nine patients required dialysis post-intervention; six were temporary, and three permanent. Perioperative complications occurred in 2/11 patients. In 55%, the cause of occlusion was undetermined. Median follow-up was 18.5 months (IQR 0-33). CONCLUSION: Delayed renal stent graft recanalisation is safe and effective, preserving renal function and avoiding dialysis in single-functioning or bilateral renal artery occlusions. Recanalisation should be considered aggressively when renal perfusion remains, regardless of occlusion duration.