Background: Unintentional renal artery occlusion after endovascular aneurysm repair (EVAR) for abdominal aortic\naneurysm remains one of the most unfavorable complications. Renal salvage options include percutaneous\ntransluminal renal artery angioplasty (PTRA) and open hepatosplenorenal bypass. However, the usefulness of kidney\nautotransplantation (AutoTx) remains unclear.\nCase presentation: A 76-year-old woman with a right solitary kidney attributable to a left renal thromboembolism\nhad previously undergone EVAR with a stent graft for an infrarenal aortic aneurysm, which led to ostial occlusion of\nthe right renal artery. In addition, she had undergone PTRA and stenting. Two days before admission, she\ndeveloped leg edema and hypertension, leading her to visit the hospital. Her serum creatinine level was 2.4\n(baseline, 1.0) mg/dL. Acute kidney injury due to renal artery in-stent restenosis was suspected; re-angioplasty was\nattempted on day 2 of hospitalization, but was unsuccessful. Her renal function did not improve and anuria\npersisted; thus, hemodialysis was initiated on the same day. The right kidney size (8.6 cm) was preserved relative to\nher body size, with only mild cortical atrophy. Doppler ultrasonography and mercaptoacetyltriglycine scintigraphy\nrevealed minimal but significant perfusion of the right kidney. Therefore, we considered that kidney perfusion was\nsustained and renal function could be reversed. On day 25 of hospitalization, right kidney AutoTx to the right iliac\nfossa was performed to reestablish adequate renal perfusion and reverse the need for dialysis. Soon after the\nprocedure, the patient started passing urine. Her renal function improved; her serum creatinine level decreased to\n1.0 mg/dL on day 33 of hospitalization. Hemodialysis was discontinued after the surgery. Zero-hour kidney biopsy\nshowed only mild tubular injury, with neither tubular necrosis nor glomerular abnormalities.\nConclusions: Kidney AutoTx can be performed for patients with renal artery in-stent occlusion after unsuccessful\nPTRA who previously underwent EVAR. Our case showed successful recovery of renal function nearly 1 month after\nrenal artery occlusion, indicating that revascularization should be considered even if it is delayed, as the kidney\nmight be perfused through collateral circulation.
Loading....