gms | German Medical Science

Introduction: Devascularization of a single kidney, irrespective of the cause, may result in renal failure in patients with borderline kidney function or can cause development of arterial hypertension with the known longterm risks. Kidney failure and subsequent dialysis is known to negatively affect live expectancy and quality of live.

Material and methods: An 83-year-old male patient with a large aortic aneurism (82 mm diameter) underwent EVAR therapy in our institution. The procedure was performed as a hybrid procedure engaging radiology and vascular surgery. After placement of the graft, a typ IA endoleak occurred on the proximal docking point which made placement of an elongation prosthesis necessary. Thereafter the endoleak seized but sufficient blood flow to the right renal artery could no longer be detected in angiography.

Results: Interventional attempts to probe the right renal for stenting were unsuccessful. Taking into account the amount of contrast agent administered and the patients’ retention level prior to surgery that showed a creatinine of 1.19 mg/dl, it was decided that immediate surgical revascularisation of the renal artery would be the most efficient mean to secure renal function. Surgical access was gained by an extraperitoneal approach in order to spare the patient opening of the abdominal cavity. Access to the renal artery was achieved and a 6 mm PTFE end to side bypass was established between the right renal artery and the exterior iliac artery. All in all warm ischemia time of 2,5 hours was documented. Unfortunately the postoperative course was complicated by a bleeding episode from a surgical lazeration of the upper kidney pole which made further operations necessary. Postoperative Angio-CT Control showed no sign of endoleakage and patent reno-iliacal bypass.

6 months after the initial procedure the patient presented in a good clinical condition with compensated kidney function with slightly elevated creatinin levels of 1,54 mg/dl and no sign of arterial hypertension. He received a control scan, ruling out endoleackage after aortic stenting, showing slightly delayed contrast enhancement of the right renal artery via the established bypass. Also a szintigraphy analysis of split renal function was done, in which the right kidney showed 43% of overall function.

Conclusion: As kidney function could be preserved in our patient, we report this to be a safe and effective treatment option, which should be taken into consideration in cases of accidental renal devascularization, in patients at risk for renal failure. To our knowledge no such treatment option has been reported as an immediate repair after an endovascular complication. This case also emphasizes the importance of adequate hospital infrastructure and interdisciplinary work between interventional radiologists and vascular surgeons when it comes to challenging endovascular intervention therapies.

Figure 1 [Fig. 1]