PMC9951820_01
(Left) A remnant infrarenal aortic sac with a 12 mm lumen (blue arrow). (Right) A loop of the bowel (duodenum) is seen apposed to the anteroinferior aspect of the aortic sac (white arrow).
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FIG1
A fat stranding was found in the vicinity, but no active contrast extravasation or retroperitoneal hematoma (Figure 1).
Incidental intestinal polyp in the D3/D4 segment of the duodenum (white arrow) and mucosal defect (blue arrow).
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FIG2
Schematic demonstration of the placement of renal stents in a "chimney-like" configuration (blue arrows), embolic plugs/coils within the aortic sac (black arrow), and relationship to the SMA (red arrow).. Illustrated by Dr. Amos Tan.. SMA: Superior mesenteric artery.
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FIG3
A 7 mm x 57 mm Begraft (Bentley InnoMed GmbH, Hechingen, Germany) was advanced into each renal artery in a 'chimney-like' configuration, ensuring at least half the length of the stents was in the aorta, with their proximal ends resting on the contralateral aortic wall, to provide them with stability (Figure 3).
(A) Pre-stenting angiogram demonstrating the relationship of the renal arteries (blue arrows), SMA (red arrow), and aortic sac (black arrow). (B) Angiogram performed after renal artery stenting demonstrates the position of the stents within the renal arteries (blue arrows). A tiny marker within the aortic sac (black arrow) demonstrates the position of the vascular plug. (C) Completion angiogram performed after SMA stenting demonstrates flow within the stented SMA (red arrow) and renal arteries (blue arrows). Vascular plug and coil seen within the aortic sac (black arrow).. SMA: Superior mesenteric artery.
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FIG4
California) was packed into the corners around the plug and below the crossing stents. As the protruding aortic segments of two renal stents could interfere with the flow into the SMA and clot progression from the embolic materials in the aortic stump could encroach the SMA ostium, an 8 mm x 57 mm BeGraft (Bentley InnoMed GmbH, Hechingen, Germany) was deployed into the SMA, once again in a chimney-like configuration. Completion angiogram showed good occlusion of the aortic stump with patent stents (Figure 4).
CT aortic angiogram six months post corrective surgery. (A) coronal, (B) sagittal, (C) axial, and (D) 3-dimensional reformat centered on the aortic stump (black arrow) demonstrates good perfusion of the SMA (red arrows) as well as both renal arteries (blue arrows). . SMA: Superior mesenteric artery.
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FIG5
CT aortogram performed six months post-surgery demonstrated patency of the superior mesenteric and bilateral renal grafts (Figure 5) with no tethering of bowel loops to the aortic stump, pseudoaneurysm, contrast extravasation or migration of the stents, vascular plug, and coils.