Embolization of a wide-necked aneurysm of the renal artery ostium using an Amplatzer vascular plug 2 - a case report

Sep 30, 2026

Uploaded by Oliver

Embolization technique using a steerable sheath and an Amplatzer vascular plug 2 (AVP 2) is presented for a wide-necked renal artery ostial aneurysm directly attached to the aortic wall. Owing to a high risk of extra-target embolization, coils, liquid agents, and covered stent placement were not feasible. A 45-year-old patient underwent endovascular embolization under local anesthesia with fluoroscopic and cone-beam CT guidance. Follow-up showed durable plug position, aneurysm exclusion, and partial size reduction at 7 months, without complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Background

Case presentation

Conclusions

Background

Renal artery aneurysms and treatment rationale

Case presentation

Imaging and clinical history

Ghosn et al. CVIR Endovascular (2026) 9:1 [https://doi.org/10.1186/s42155-025-00607-1](https://doi.org/10.1186/s42155-025-00607-1) CVIR Endovascular CASE REPORT Open Access Embolization of a wide-necked aneurysm of the renal artery ostium using an Amplatzer vascular plug 2: a case report Mario Ghosn1* , Haytham Derbel 1, Youssef Zaarour1, Félix Wei1, VaniaTacher1,2 and Hicham Kobeiter 1,2 Abstract Background This report describes an embolization technique using a steerable sheath and an Amplatzer vascular plug 2 (AVP 2) to treat a wide-necked aneurysm located at the ostium of the renal artery. Given this particular location, directly attached to the aortic wall, similar to a saccular aneurysm of the abdominal aorta, stent placement or embolization using coils or liquid agents was not feasible. Case presentation A 45-year-old patient with a long medical history including heterozygous SC sickle cell disease, systemic lupus erythematosus, and a left iliac fossa kidney transplant presented with a partially thrombosed right renal artery aneurysm of 45-mm diameter. The aneurysm was located at the ostium of the renal artery that was occluded downstream. The aneurysm was directly attached to the aortic wall with a wide neck measured at 8 mm. Use of coils or liquid agents was not possible because of a very high risk of extra-target embolization. Lack of a patent right renal artery downstream precluded placement of a covered stent. Following multidisciplinary discussion, and due to the patient’s high risk for aortic abdominal surgery, endovascular management with embolization was decided. Embolization was performed under local anesthesia, using fluoroscopic guidance and a cone-beam computed tomography three-dimensional road map. Following common right femoral artery access, a 7F steerable sheath was used to catheterize the aneurysm. An AVP 2 was then passed through the sheath in the aneurysm. Particular attention was paid to deploying the last disc of the AVP 2 in the aortic lumen to ensure closure of the aneurysm neck. Final aortic angiogram confirmed exclusion of the aneurysm. There were no intraoperative or postoperative complications. At computed tomography performed 7 months later, the AVP 2 remained in position, and the aneurysm was excluded and partially decreased in size. Conclusions In an anatomical presentation that was not a candidate for stent placement or classic embolization techniques, deployment of an AVP 2 using a steerable sheath successfully excluded the aneurysm. This procedure, performed under local anesthesia, obviated the need for abdominal aortic surgical repair or for an aortic stent graft. Keywords Renal aneurysm, Abdominal aorta, Vascular plug, Endovascular, Embolization *Correspondence: Mario Ghosn[ghosn. mario1@gmail.com](ghosn. mario1@gmail.com) 1 Department of Radiology, Henri Mondor Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), Créteil, France 2 Université Paris-Est Créteil (UPEC), Créteil, France Background Renal artery aneurysms (RAA) rupture can lead to a patient’s death or loss of a kidney. According to the Cardiovascular and Interventional Radiological Society of Europe, RAA must be treated if it has a size > 2 cm [1]. Endovascular treatment has a high technical success rate [2–4], with different techniques reported, including coiling [5, 6], use of liquid embolic agents [2], and stent grafts [7]. © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material

FAQs

Why were coils, liquid agents, and stent grafts not feasible in this case?

The aneurysm’s anatomy at the renal artery ostium and its wide neck created a very high risk of extra-target embolization, and downstream right renal artery occlusion prevented covered stent placement.

What device and technique were used for the embolization?

A steerable sheath was used to catheterize the aneurysm, and an Amplatzer vascular plug 2 (AVP 2) was deployed with attention to seating the last disc in the aortic lumen to close the neck.

What were the procedural and follow-up outcomes?

There were no intraoperative or postoperative complications. At 7 months on computed tomography, the AVP 2 remained in position, the aneurysm was excluded, and its size partially decreased.

Sep 30, 2026

Uploaded by Oliver