Back to 2016 Annual Symposium ePosters

INTRODUCTION:
Acute renal artery occlusion is an uncommon phenomenon with an incidence of <0.01%. The majority of cases are secondary to embolic events, aortic dissections, acute/chronic thrombosis, or traumatic injury. Historically, revascularization after several hours was felt to be futile. This may not remain true, as advancements in imaging has shown renal mass can be preserved secondary to capsular flow.
CASE:
We report a case of a 71 year old female who underwent a FEVAR. During routine one-year follow-up she was noted to have stenosis of her left renal stent. Angiography revealed stenosis at the distal aspect of her stent and the lesion was treated with a stent. Seven days later, she presented to an outside emergency department with an 18-hour history of acute left flank pain. She had an elevation in her creatinine to 2.7 mg/dL from1.6 mg/dL. Renal artery duplex revealed occlusion of her left renal artery stent.
The patient was transferred to our institution 30 hours after onset of symptoms and was brought to the interventional suite for treatment. Upon arrival, the patient’s creatinine had increased to 3.7 mg/dL. The left renal artery occlusion was traversed and angiography confirmed patency of the distal left renal vasculature. Thrombolysis with TPA was initiated with complete resolution of the stent thrombosis at 12 hours with enhancement of the kidney on angiography. No identifiable cause for thrombosis could be detected and the stent was re-dilated. The patient was initiated on anticoagulation and nuclear medicine evaluation showed 22% function in the left kidney at three months with an improved creatinine of 2.7 mg/dL. At one-year follow-up, the patient continues to have stable renal function, and renal duplex showing normal resistive indices. The patient’s antihypertensive regimen is well-controlled with only two medications from four. We have been successful in revascularization in three of four patients with this approach.
DISCUSSION:
Revascularization and preservation of renal function in an occluded renal artery stent can be successful despite prolonged ischemia. Although patients may not recover all renal function, some function may be preserved. The presence of parenchymal vessel patency from cortical blood flow may account for the preservation of renal function. Aggressive attempts at treatment can be beneficial in appropriately chosen patients and may decrease the risk of future dialysis.