Surgical Salvage of Acute Renal Artery Occlusion in the Setting of a Solitary Kidney

Abstract

Management of acute renal artery occlusion in patients with a solitary kidney has a poorly defined prognosis. Loss of renal function is reported by some when acute warm ischemia reaches 2 hours. We report a unique case of a patient that had a 24-hour onset of anuria and acute renal failure upon arrival to the hospital. Nuclear imaging showed trace uptake of the right kidney, without evidence of excretion. Conventional digital subtraction angiography was performed; however, evidence of nephrogram or distal filling of the renal artery was not demonstrated. Secondary to conflicting studies, a computed tomography of the abdomen and pelvis with intravenous contrast revealed only minimal cortical perfusion despite complete occlusion of the previously grafted right renal artery. Patient was taken for urgent hepatorenal bypass surgery. Intraoperative return of urine output occurred immediately after completion of the bypass. Hemodialysis, which was required preoperatively, was stopped after <30 days of bypass procedure. Over 2 years following successful renal salvage, the patient has maintained a normal glomerular filtration rate and patency of her bypass by duplex follow-up.

Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching

“…Furthermore, no recommendation exists on how long after the occlusion a treatment attempt should be done and whether only patients with a solitary kidney and bilateral occlusion should be treated. The current literature [7][8][9][10][11][12][13][14][15][16][17][22][23][24][25][26][27][28] on renal function salvage after delayed treatment mainly consists of case reports and very small series. Considering the low evidence in the field, decision-making is not always easy.…”

“…Regarding the lack of evidence for open or interventional treatment of RAO, only a few case reports and small series have reported on renal function salvage after delayed revascularization. [7][8][9][10][11][12][13][14][15][16][17] Herein is presented a singlecenter experience with acute RAO and delayed renal artery revascularization after fenestrated-branched EVAR or open visceral debranching.…”

Acute thromboembolism in a solitary kidney: revascularization by means of isolated transcatheter thrombus aspiration

“… 2 Surgery has a limited role in the non-trauma setting, 2 , 5 although a bypass procedure might be considered in case of acute complete occlusion of the main renal artery. 6 On the other hand, percutaneous endovascular therapies have been reported to be worthwhile, with some studies showing clear benefit with a delay of several days 2 , 7 or even weeks. 8 , 9 Nevertheless, poor outcomes with early intervention have also been reported, 1 making the therapeutic window still unclear, especially because the literature is scarce.…”