Compression of the left renal artery and celiac trunk by diaphragmatic crura

Abstract

Symptomatic compression of the celiac trunk by crura of the diaphragm is a rare disorder. Even more infrequent external compression of renal arteries is found. Although the indication for surgical therapy is controversially discussed in the literature for celiac artery compression syndrome, it is unequivocally for renal artery entrapment. We present the case of a young woman who was assigned to our hospital with arterial hypertension and stenosis of the left renal artery. After percutaneous transluminal angioplasty was performed, immediate recoil occurred. Therefore, the suspicion of entrapment by diaphragmatic crura was expressed. Additionally performed diagnostic procedures including computed tomography (CT)-angiography verified our suspicion. Surgical decompression of both vessels was successfully performed.

Renal artery entrapment — anatomical risk factors rating

“…The focal narrowing had a characteristic hooked appearance, which helped distinguish this condition from other causes of coeliac artery narrowing, such as atherosclerotic disease [9]. Coexistence of extrinsic compression by crura of diaphragm on CT and RA is very infrequent and only a few cases have been reported in the literature [8]. Therefore three presented cases seem to be exceptional.…”

“…Occasionally, in addition to the RA, the constricting effects may also be exerted on the SMA and the CT [8,10]. We reported 3 cases presenting this disorder (Fig.…”

“…The mechanism evoked is an anomaly of migration of the kidneys [3,18], which seems to be more common on the left side. The diaphragmatic fibres cause verticalisation of the root of the RA and lead to stenosis [4,8,19]. During kidney migration to the retroperitoneal abdomen from the pelvis, metanephros vasculature is dynamic.…”

Laparoscopic treatment of renal artery entrapment

“…[10][11][12] Not surprisingly, balloon angioplasty failed in these cases due to elastic recoil, and stenting failed due to bending and fracture of the implanted stent. [9][10][11]13 Since renal artery entrapment has an extrinsic etiology, we strongly suggest to also treat it from outside of the renal artery. Therefore, angioplasty and stenting must be excluded from the management of this pathology.…”

“…8,9 The combination of RA with CA entrapment, as present in our patient, is very infrequent. 4,5,10 Treatment is generally recommended when symptoms exist that are related to the vessel constriction. As a result of From the Department of Surgery a and the Institute for Diagnostic and Interventional Radiology, b University of Rostock.…”