Aortic stent-grafting with transrenal fixation: use of newly designed spiral Z-stent endograft

Purpose: To evaluate the feasibility and efficacy of a newly designed stent-graft placed across the renal arteries for exclusion of abdominal aortic aneurysms (AAAs) with short or tortuous proximal necks. Methods: Among a group of AAA patients treated with endovascular grafting, 5 had tortuous proximal necks and 13 had necks Results: The stent-grafts were correctly placed at the intended site in all 18 patients. Renal function was not affected except transiently in 1 patient who developed bilateral renal artery stenoses 24 hours after the procedure; Palmaz stents were deployed in each renal artery to reestablish satisfactory blood flow. Of the 33 renal arteries crossed by the bare stent-graft segment, all were patent over a mean 14-month follow-up (range 7–24), including the patient with Palmaz stents implanted for postprocedural renal stenosis. Complete aneurysm exclusion was maintained in 15 (83%) of 18 patients; proximal leaks persisted in 3 patients, including 2 with severely angled proximal necks. Conclusions: Transrenal placement of the uncovered leading edge of custom-made spiral Z-stent—based endografts appears feasible and clinically effective in the treatment of AAAs with short or tortuous proximal necks.