Embolization of a wide-necked aneurysm of the renal artery ostium using an Amplatzer vascular plug 2: a case report

TL;DR

A new embolization technique using an Amplatzer vascular plug successfully treated a complex renal artery aneurysm that couldn't be addressed with traditional methods.

Contribution

Demonstrates successful use of AVP 2 with a steerable sheath for aneurysm embolization in a non-standard anatomical location.

Findings

AVP 2 deployment via steerable sheath successfully excluded a wide-necked renal artery aneurysm.

Procedure was performed under local anesthesia with no intraoperative or postoperative complications.

Aneurysm remained excluded and partially reduced in size at 7-month follow-up.

Abstract

This report describes an embolization technique using a steerable sheath and an Amplatzer vascular plug 2 (AVP 2) to treat a wide-necked aneurysm located at the ostium of the renal artery. Given this particular location, directly attached to the aortic wall, similar to a saccular aneurysm of the abdominal aorta, stent placement or embolization using coils or liquid agents was not feasible.

A 45-year-old patient with a long medical history including heterozygous SC sickle cell disease, systemic lupus erythematosus, and a left iliac fossa kidney transplant presented with a partially thrombosed right renal artery aneurysm of 45-mm diameter. The aneurysm was located at the ostium of the renal artery that was occluded downstream. The aneurysm was directly attached to the aortic wall with a wide neck measured at 8 mm. Use of coils or liquid agents was not possible because of a very high risk of extra-target embolization. Lack of a patent right renal artery downstream precluded placement of a covered stent. Following multidisciplinary discussion, and due to the patient’s high risk for aortic abdominal surgery, endovascular management with embolization was decided. Embolization was performed under local anesthesia, using fluoroscopic guidance and a cone-beam computed tomography three-dimensional road map. Following common right femoral artery access, a 7F steerable sheath was used to catheterize the aneurysm. An AVP 2 was then passed through the sheath in the aneurysm. Particular attention was paid to deploying the last disc of the AVP 2 in the aortic lumen to ensure closure of the aneurysm neck. Final aortic angiogram confirmed exclusion of the aneurysm. There were no intraoperative or postoperative complications. At computed tomography performed 7 months later, the AVP 2 remained in position, and the aneurysm was excluded and partially decreased in size.

In an anatomical presentation that was not a candidate for stent placement or classic embolization techniques, deployment of an AVP 2 using a steerable sheath successfully excluded the aneurysm. This procedure, performed under local anesthesia, obviated the need for abdominal aortic surgical repair or for an aortic stent graft.

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