A case of endovascular treatment for juxtarenal aortic calcified occlusion with intermittent claudication

Abstract

We focused on the importance of procedure strategy for the planning of treatment in a patient with calcified occlusive abdominal aorta with bilateral renal artery stenosis showing intermittent claudication. A 76-year-old man was admitted to our hospital with acute decompensated heart failure. He had a history of hypertension, dyslipidaemia, chronic kidney disease, smoking habit, heavy alcohol intake, and coronary artery bypass graft surgery 6 years ago. Examination revealed that the abdominal aorta was nearly completely occluded due to a large calcified nodule involving bilateral renal arteries. Because he suffered from bilateral intermittent claudication, we decided to undertake revascularization of the abdominal aorta and left renal artery by endovascular treatment (EVT) in a single session. We aimed to secure disappearance of the pressure gradient, but not full distension of the abdominal aorta. We undertook EVT with balloon-expandable stent in order to maintain superior mesenteric artery flow and to ensure firm dilation of the left renal artery. For the calcified abdominal aorta, we tried to construct bidirectional routes of abdominal aortic blood flow antegradely and retrogradely. Our technique is less invasive than bypass surgery and can be performed safely under local anaesthesia using percutaneous access.