# Endovascular Repair of Abdominal Aortic and Iliac Aneurysms Complicated by Multiple Endoleaks, Renal Dysfunction, and Urological Interventions

## TL;DR

This paper presents a complex case of abdominal aortic aneurysm repair complicated by multiple severe issues, highlighting the need for careful management and multidisciplinary care.

## Contribution

The paper reports a rare case with the coexistence of multiple severe complications following endovascular repair.

## Key findings

- The patient experienced recurrent endoleaks, renal dysfunction, and urological complications after EVAR.
- Multidisciplinary interventions partially restored renal function despite severe complications.
- The case emphasizes the importance of early recognition and proactive strategies in managing such complex cases.

## Abstract

Abdominal aortic aneurysm (AAA) is a serious vascular condition often treated with endovascular aneurysm repair (EVAR). While EVAR is less invasive than open surgery, it may lead to complications, particularly in patients with risk factors. Acute kidney injury (AKI), endoleaks, and ureteral obstruction are among the most severe. The uniqueness of this case lies in the rare coexistence of multiple severe complications - recurrent endoleaks, renal dysfunction, and irreversible urological damage, occurring together in a single patient.

We present a case of a 61-year-old man with chronic kidney disease stage 4, atherosclerosis, atrial fibrillation, hypertension, and prior myocardial infarctions, who presented with abdominal aortic and iliac artery aneurysms. Initial EVAR with a bifurcated stent graft was successful. Three months later, complications began, including recurrent AKI, type IB and later type IA endoleak, type II endoleak, renal artery stent occlusion, hemorrhagic complications, and obstructive uropathy. Management included multiple reinterventions: nephrostomy placement, selective embolization, and relining of the renal artery stent via axillary access. Despite episodes of anuria and the need for dialysis, renal perfusion was partially restored following final stenting. Follow-up scintigraphy confirmed improved renal function.

This case demonstrates the complexity of managing EVAR complications in patients with advanced renal dysfunction and systemic vascular disease. It underscores the importance of multidisciplinary care, early recognition of endoleaks, and proactive renal protection strategies to improve patient outcomes.