Endovascular aneurysm repair (EVAR) has gained widespread acceptance as the procedure of choice for repair of infrarenal abdominal aortic aneurysms (AAA) in patients with suitable aortic anatomy [
1]. The improvement of the technique and surgeon’s skills has extended the possible indication for repair to patients with a more complex aortic anatomy [
1,
2]. Despite these improvements, the main anatomic limitation to EVAR is the proximal aortic-neck anatomy. There is no consensus about the method of choice to repair suprarenal or juxtarenal AAAs [
2]. Open repair is an effective method, yet the post-operative risks and the high morbidity and mortality rates make this operation suitable to low-risk patients [
3]. The standard EVAR procedure for infrarenal AAAs cannot be applied to suprarenal or juxtarenal AAAs since it is accompanied by high rate of adverse events including proximal endoleak, migration and mainly aortic side branches occlusion with possible renovisceral ischemia [
1,
2,
4]. Novel modifications of the traditional EVAR procedure have evolved in order to offer less invasive approach to repair suprarenal or juxtarenal AAA. The fenestrated and branched EVAR techniques have gained popularity as a possible alternative to open repair or standard EVAR techniques that would not compromise blood perfusion to the aortic side branches, since the sealing and/or fixation zone is translocated proximal or distal away from the target vessels [
4,
5]. However, the endovascular stent grafts that are used in the fenestrated and branched EVAR are custom-made and require measuring, fitting and a period of time for graft preparation and supply. Therefore, these two costly techniques are only suitable for elective repair of AAA and not in emergent cases [
1,
2,
4,
5]. In 2003, Greenberg
et al, have introduced the novel chimney graft (CG) procedure (a.k.a. the “snorkel technique”) in order to overcome some of the limitations of the fenestrated and branched EVAR [
6]. The CG technique involves placing of parallel stent grafts adjacent to the main body of the aortic endograft to maintain blood supply to renal and other visceral branches post- aneurysm exclusion. Contrary to EVAR with the fenestrated or branched technique, the CG technique involves standard off-the-shelf stent grafts and can be used in emergent cases [
1,
2]. Possible indications for the use of CGs, other than treating suprarenal and juxtarenal abdominal aortic aneurysms, include thoracic and thoracoabdominal aneurysms with supraortic branches orifice involvement and suitable cases of common iliac artery aneurysms with or without internal iliac artery involvement [
7,
8]. A potential major drawback of the EVAR procedures is the presence of endoleaks (
i.
e. persistent flow of blood into the aneurysm sac after device placement). Endoleaks were reported to complicate up to 25% of EVAR operations with CG placement. However, endoleak repair not necessary in most cases [
1].
Hereby we present a novel etiology of malignant renovascular hypertension caused by a renal artery CG occlusion.