Abstract

Abdominal aortic aneurysms (AAA) can be repaired with endovascular aneurysm repair (EVAR), a minimally invasive procedure, in some comorbid conditions. In some anatomical situations, EVAR can be difficult to perform, and these anatomical difficulties can affect the success of EVAR. The chimney endovascular technique can be used in the repair of juxtarenal abdominal aortic aneurysms, one of these anatomical challenges. The purpose of this case report is to present the treatment of a complicated juxtarenal aortic aneurysm with a very large distance between the right and left renal arteries using the chimney technique. A 62-year-old man presented with abdominal pain and a juxtarenal abdominal aortic aneurysm measuring 57.4 mm at its widest point was detected on contrast-enhanced computed tomography. Evaluation of the patient's computed tomography images revealed that the right renal artery originated from the abdominal aneurysm sac, with a distance of approximately 53.3 mm from the left renal artery. The patient underwent EVAR using the chimney technique. Routine blood tests revealed no pathology at the 1-month postoperative follow-up. Contrast-enhanced computed tomography revealed renal graft patency and confirmed the absence of an endoleak. This case report emphasizes that EVAR strategies are case-specific and that specific strategies should be developed for certain anatomical challenges. In the presence of comorbidities, the chimney technique should be considered a solution-oriented method for juxtarenal aneurysms.

Key words: Endovascular aneurysm repair, abdominal aortic aneurysm, vascular surgery, chimney technique