Proximal Type I Endoleak After Previous EVAR With Palmaz Stents Crossing the Renal Arteries: Treatment Using a Fenestrated Cuff

Purpose To report the use of a fenestrated cuff for endovascular treatment of a proximal type I endoleak after previous endovascular aneurysm repair (EVAR) that included 2 suprarenal cuffs and 2 Palmaz stents.Case Report A 71-year-old man had been treated for an infrarenal abdominal aortic aneurysm with a Powerlink stent-graft, 2 additional proximal cuffs with suprarenal fixation, and 2 Palmaz stents extending over the renal arteries. Follow-up demonstrated a type I endoleak and an increase in aneurysm size. A 2-stage endovascular approach featuring a fenestrated cuff was undertaken. Prior to the endoleak repair procedure, both renal arteries were catheterized and the Palmaz stent struts dilated. When the customized fenestrated cuff was available, it was successfully positioned with covered stents in the fenestrations, completely excluding the proximal type I endoleak.Conclusion Fenestrated stent-grafting is a viable alternative to open repair after failed EVAR, even when previously implanted bare metal stents cross the renal orifices.