Background: Open Repair (OR) remains the “gold standard” for treatment of AAAs and Juxtarenal
Aneurysms (JAAA), although there is an increased morbidity and mortality rate, longer
operating time, and higher need for transfusions. Endovascular repair (EVAR) offers
an alternative as it obviates the need for extensive surgical dissection. Fenestrated
EVAR (f-EVAR) devices are used in JAAA to overcome the insufficient neck length resulting
in inadequate sealing of standard endografts. Chimney-graft technique EVAR (Ch-EVAR)
has been employed to preserve the visceral aortic branches, deploying a stent parallel
to the aortic endograft allowing the sealing in a healthier aortic zone. A recent
review of the Ch-EVAR showed promising results in terms of morbidity, mortality, and
durability at 6 and 12 months follow-up. Method(s): We present a unique case of a juxtarenal AAA (J-IAAA) with contained leak in the
presence of an indwelling aortic stent with disintegration and kinkage of stent successfully
treated with Ch-EVAR. Result(s): Patient was successfully treated with EVAR and bilateral renal artery chimney-grafts
(Ch-EVAR). Conclusion(s): Ch-EVAR shows is valid and viable treatment as well as bail out option for challenging
cases of JAAA, where a custom-made device is either not available or not amenable
to deployment due to difficult access.
