Renal Autotransplant for Subsequent Endovascular Exclusion of the Thoracoabdominal Aorta

• Published in: Annals of vascular surgery Vol. 27; no. 7; pp. 974.e1 - 974.e6
• Main Authors: Espinosa, Gaudencio, Grochowicz, Lukasz, Pascual, Ignacio, Lavilla, Javier, Olavide, Isidro, Hernández, Miguel David, Landecho, Manuel Fortún, Lucena, Juan Felipe, Bastarrika, Gorka, del Pozo, José Luis, Gavira, Juan José, Alegre, Félix
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2013
• Subjects: Aged; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Celiac Artery - surgery; Endovascular Procedures - instrumentation; Female; Humans; Kidney Transplantation; Laparoscopy; Mesenteric Artery, Superior - surgery; Nephrectomy - methods; Prosthesis Design; Reoperation; Stents; Surgery; Tomography, X-Ray Computed; Transplantation, Autologous; Treatment Outcome
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2012.11.010

In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.