case_images: PMC10766739_01
case_images: Fig. 1 Serial enhanced CT. (A) CT just before the intervention shows a large aneurysm, 53 mm in diameter, deriving from the LRV. (B) Immediately after the procedure. The left renal vein is patent. (C) One year after the procedure. The aneurysm has disappeared completely. No thrombus is present in the LRV. CT: computed tomography; LRV: left renal vein.
case_images: avd-16-277-g001.jpg
case_images: PMC10766739_01_avd-16-277-g001.jpg
case_images: figure1
case_images: The aneurysm kept gradually enlarging and had reached 53 mm (Fig. 1A), although the lower back pain had almost disappeared. CT just after the procedure still showed the remnant aneurysm sac (Fig. 1B). The aneurysm shrank and had completely resolved by 12 months after EVT, without any renal vein thrombosis or obstruction (Fig. 1C).
case_images: Fig. 2 Angiography during the procedure. (A) A 22-mm AVP II in the aneurysm neck obstructs the renal vein. The adrenal vein and the testicular vein are proximal to the aneurysm. (B) A 10-mm AVP II cannot close the neck completely. (C) A 16-mm AVP II in the neck. Collateral circulation functions for the venous return from the upper branch. (D) A 16-mm AVP II in the neck. The venous return from the lower branch is no problem. AVP: Amplatzer vascular plug.
case_images: avd-16-277-g002.jpg
case_images: PMC10766739_01_avd-16-277-g002.jpg
case_images: figure2
case_images: When the aneurysm neck was closed with a 22-mm Amplatzer vascular plug (AVP) II (Abbott, Abbott Park, IL, USA) with one lobe of the device positioning in the renal vein and two lobes in the aneurysm, the renal vein itself was completely occluded (Fig. 2A). AVP II, it did not occlude the renal vein, while the neck was incompletely closed (Fig. 2B). Although an additional plug would be required to completely occlude the neck, placing a 10-mm AVP II in the neck first to restrict blood flow appeared safe and effective. We confirmed that the venous return from the upper branch could flow through collateral circulation (Fig. 2C) and the return from the lower branch was not obstructed (Fig. 2D).