Endovascular thrombectomy of a renal artery chimney stent-graft using the Solitaire recanalization device.

The chimney graft technique is gaining popularity as an alternative endovascular treatment for juxtarenal aneurysms not suitable for standard or fenestrated endovascular aneurysm repair (EVAR).1–6 Despite excellent technical success,1,3–6 limited data are available regarding the long-term effectiveness of the technique, particularly in terms of chimney stent occlusion. This complication may have catastrophic consequences and represents a challenge for any endovascular approach, requiring in most the cases an open surgical bypass to restore vessel patency. Donas et al.1 used open thrombectomy to treat a renal chimney graft thrombosis. We encountered a symptomatic acute thrombosis of a renal chimney stent-graft, which we successfully treated with endovascular thrombectomy using a recanalization device that, in a recent article in the JEVT, proved useful in treating acute popliteal thrombosis.7 The 77-year-old man with multiple comorbidities and a 10-year-old Vanguard aortic endograft was successfully treated for a 55- mm juxtarenal aortic aneurysm and endograft migration (Fig. 1A). Two proximal aortic cuffs [Endurant (Medtronic Cardiovascular, Santa Rosa, CA, USA) and Zenith Low Profile (Cook Medical, Bloomington, IN, USA)] were positioned across the aneurysmal segment, and a 6359-mm covered balloon-expandable stent (Advanta V12; Atrium Medical Corporation, Hudson, NH, USA) was placed using the chimney technique in the left renal artery via a combined axillary and femoral artery access. The postoperative course was uneventful, and the patient was discharged on dual antiplatelet therapy...