Parallel Grafts Are A Viable Technique For Urgent Para-renal Aneurysm Repair In The Setting Of Prior Aortic Repair
Matthew Vuoncino, M.D., Kathryn DiLosa, MD, Matthew Schneck, MD, Mimmie Kwong, MD, Misty Humphries, MD, Shaun M. Gifford, MD, Steven Maximus, MD.
UC Davis, Sacramento, CA, USA.
Objectives: Ruptured pararenal aneurysms present technical challenges for repair, with increasing complexity in the setting of a prior aortic surgery. Parallel stent grafting provides an “off the shelf” option in patients with unfavorable aortic anatomy but its use in the setting of rupture is poorly described. Methods: We present a series of 6 patients that underwent parallel stent graft repair for ruptured pararenal abdominal aortic aneurysms (AAA). Patient demographics, anatomic and clinical factors, procedural details, and outcomes were reviewed.Results: Between 2019 and 2022, 6 patients underwent parallel stent graft repair for ruptured AAA. Of these, 4 (66.7%) had previously undergone AAA repair (1 open, 3 endovascular including 1 with prior visceral stents). In addition to bilateral groin access, all patients had right axillary artery exposure for balloon expandable stenting of target vessels (6 renal, 4 mesenteric). Mean operative time was 289.5±100.1 mins, including fluoroscopic time of 56.6±22.6 mins. Mean contrast volume was 198 ml. All patients had stable renal function postoperatively, excluding the one patient where the renal vessels were covered intentionally. No patients had evidence of endoleak on 30-day follow up imaging. Thirty-day survival was 100%. Average hospital stay was 7.6±4.3 days, with 2.2±1.2 days in the ICU. We observed no perioperative stroke, myocardial infarction, or other major complications. All grafts remained patent without device migration or endoleak at mean follow up of 184±189.1 days. Conclusion: The use of parallel stent grafts for ruptured para-renal aortic aneurysms provides a safe and readily available technique that is particularly effective in patients with a previous aortic repair. 
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