Renal Revascularization With X-Crossing Technique During Complex Aortic Aneurysm Repair Using Branched Endograft

PURPOSE: To delineate the strategic approach of the renal branches x-crossing technique in enhancing endovascular treatment of thoracoabdominal (TAAA) and pararenal aortic aneurysms (PAA) using off-the-shelf T-Branch endograft. TECHNIQUE: A 72-year-old woman treated with urgent branched endovascular aneurysm repair (BEVAR) because of symptomatic type II thoracoabdominal aortic aneurysm (TAAA). The patient presented complex iliac and renal anatomy, with both renal arteries (RAAs) in upward takeoff, making cannulation from the respective renal branches impossible. In this case, the renal branches x-crossing technique was adopted to address that challenge, and after the deployment of the T-Branch, the cannulation of each renal artery (RA) became from the opposite renal branch, using an axillary access. To get better accommodation in RAAs, we used a self-expandable stent graft on both sides. This technique integrates procedural maneuvers and graft accommodations to ensure effective cannulation, especially in hostile renal artery configurations. CONCLUSION: The renal branches' x-crossing technique using a T-Branch endograft seems to be feasible and allows better cannulation of hostile RAAs.Clinical ImpactTo outline the strategic approach of the renal branches x-crossing technique, improving the complex endovascular treatment in hostile aortic morphology using an off-the-shelf T-Branch endograft.