Percutaneous revascularization of occluded renal arteries in the setting of acute renal failure

Abstract

Abstract:We report the case of a 60-year-old patient with acute renal failure and occluded bilateral renal arteries presenting with acute pulmonary edema and non-ST segment elevation myocardial infarction. The patient required renal replacement therapy with hemodialysis and was subsequently successfully treated with bilateral renal artery stent placement. Marked improvement in renal function was noted within 1 week with freedom from the need for renal replacement therapy at 4 months of follow-up.

Endovascular Revascularization of a Renal Branch Occlusion in a Monorenal Patient after a 3-Branched Stent Graft Procedure of the Abdominal Aorta

“…Nevertheless, despite a successful surgical or endovascular revascularization, 25% of patients might not show an improvement of renal function [8]. In the present case, despite the prolonged ischemic time, the decision to treat was based on the presence of a patent distal renal artery segment and a positive nephrogram on CTA and DSA.…”

“…Successful renal function improvement after revascularization despite prolonged renal ischemia secondary to a renal artery occlusion has been reported in some cases [2,8]. A renal perfusion pressure of 20 mmHg is sufficient to prevent anoxic injury, but is not adequate to preserve tubular function; hence, prompt revascularization techniques may achieve complete or partial recovery of renal function [11].…”

“…Occlusion of branched vessels after endograft procedures might occur because of neointimal hyperplasia inside a bare stent or at the distal ends of a covered stent, leading to progressive stenosis with weeks [8]. Nevertheless, despite a successful surgical or endovascular revascularization, 25% of patients might not show an improvement of renal function [8].…”

“…Endovascular alternatives include primary stenting, angioplasty, the use of intraarterial thrombolysis, or a combination of these techniques [2,8]. Two endovascular approaches were discussed: 1) recanalization and intraarterial fibrinolytic treatment and 2) recanalization and primary stent graft placement.…”

“…Beside DSA, there are other non invasive adjunctive diagnostic imaging modalities for diagnosing renal artery occlusion including DUS, nuclear scan scintigraphy, CTA, and magnetic resonance angiography (MRA) [2,8]. Here, DUS may provide an adequate noninvasive means of renal artery stenosis and occlusion, particularly when combined with echo-enhancing agents [9].…”