Renal Artery Thrombosis Caused by Stent Fracture: The Risk of Undiagnosed Renal Artery Entrapment (original) (raw)
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Annales de Chirurgie Vasculaire, 2010
Nous rapportons un cas de thrombose de l'art ere r enale r esultant d'une rupture de stent chez un malade avec un rein fonctionnel unique. Il etait revascularis e avec succ es chirurgicalement en d epit d'une isch emie r enale de plus de 48 heures. Cet article illustre le danger de g en eraliser le stenting des l esions de l'art ere r enale ind ependamment de l' etiologie. Un pi ege de l'art ere r enale doitêtre gard e a l'esprit comme cause possible de st enose de l'art ere r enale. Le traitement des pathologies compressives par stenting peut mener a l' echec du stent. La chirurgie demeure la meilleure approche pour le traitement de ce type de l esion.
Right Renal Artery In Vivo Stent Fracture
Journal of Vascular and Interventional Radiology, 2008
The authors describe an incident of a type I single strut fracture in a right renal artery (RRA) stent resulting in ϳ90% restenosis. Fracture was observed just distal to the ostium approximately 1 year after implantation in an 83-year-old man with a history of systemic cardiovascular disease. In addition, a statistical analysis of the clinically reported cases of left renal artery (LRA) and RRA stent fracture is provided, which suggests a greater susceptibility to fracture in LRA stents as demonstrated by the greater occurrence (67%) in the left side.
Renal artery pseudoaneurysm caused by a complete stent fracture: A case report
Journal of Vascular Surgery, 2009
We report the case of a 71-year-old man with acute back and left flank pain caused by a large pseudoaneurysm of the left renal artery. The pseudoaneurysm resulted from a complete fracture of a stent that had been placed at the origin of this vessel 10 months earlier. Because the left kidney had no residual function, the patient was treated by percutaneous occlusion of the left renal artery with a vascular plug. The symptoms rapidly subsided, and he remained symptom free at the 6-month follow-up. Stent fractures, their complications, and management are discussed. ( J Vasc Surg 2009;49:214-6.) From the Departments of Vascular Surgery a and Interventional Radiology, b St. Antonius Hospital. Competition of interest: none.
Spontaneous Renal Artery Dissection: Long-term Outcomes after Endovascular Stent Placement
Journal of Vascular and Interventional Radiology, 2009
PURPOSE: To report long-term clinical and morphologic results after stent placement for spontaneous renal artery dissection (SRAD). MATERIALS AND METHODS: Between 1991 and 2006, 16 consecutive patients (13 men; mean age, 42 y ؎ 12) presented with SRAD in 17 arteries. All patients had uncontrolled hypertension at the time of presentation. Nine patients had lower back pain, 10 had progressive renal insufficiency, and three had both. All patients underwent renal angiography and stent implantation. They were followed up clinically and with renal imaging. RESULTS: Baseline blood pressure and plasma creatinine levels were 176/107 mm Hg and 142 mol/L, respectively. Successful renal artery recanalization and stent implantation were achieved in all patients. After a mean follow-up of 8.6 years ؎ 3.4, mean blood pressure was 118/78 mm Hg, with Seven patients were taking no antihypertensive medication, with five and four patients taking single or double antihypertensive agents, respectively. The most recent follow-up showed that plasma creatinine levels were normal, and imaging of the renal arteries showed no sign of restenosis or occlusion in all patients. CONCLUSIONS: Stent implantation for symptomatic SRAD is an effective treatment in the long term and represents a safe alternative to surgery.
Migration of fractured renal artery stent
Catheterization and Cardiovascular Interventions, 2011
An 80-year-old man received stent implantation for severe stenosis of the right renal artery. During the procedure, the proximal edge of the stent was successfully positioned at the ostium of the renal artery. After 6 months, follow-up renal angiography showed transverse stent fracture without restenosis. The proximal part of the fractured stent had moved and protruded into the abdominal aorta. Three years later, the proximal part of the fractured stent had migrated from the renal artery to the wall of infrarenal aorta. This is the first reported case of stent migration of the renal artery caused by a complete transverse stent fracture. V C 2011 Wiley-Liss, Inc.
Spontaneous renal artery dissection: angioplasty with stent implantation in one-year follow-up
einstein (São Paulo), 2022
Spontaneous renal artery dissection is an unusual and idiopathic condition in most cases. In young, mildly symptomatic patients, diagnosis may be difficult, frequently culminating in delay in treatment. This report presents the case of a 40-year-old male patient, with severe hypertension of sudden onset, and difficult management of oral medication. In etiological investigation, Echo-Doppler of renal arteries showed signs of hemodynamically relevant right renal artery stenosis. Arteriography showed presence of double-lumen and thrombus in the vessel lumen, indicating dissection. The proposed treatment was endovascular approach after failure of isolated medical treatment, option which included the aspiration of the thrombus by Penumbra System ® device and balloon angioplasty, followed by right renal artery stenting. Improvement of immediate sonographic control of peak systolic velocity and renal-aortic ratio was shown, with a consequent reduction of systemic arterial blood pressure and stabilization of renal function. Within the following year, the patient presented in-stent stenosis and was successfully treated with balloon angioplasty.
The management of renal artery atherosclerosis for renal salvage: Does stenting help
Journal of Vascular Surgery, 2007
Objective: The use of endovascular techniques to treat renal artery stenosis (RAS) has increased in recent years but remains controversial. The purpose of this study was to review the outcomes and durability of percutaneous transluminal angioplasty and stenting (PTA/S) for patients with RAS and decreasing renal function. Methods: Between 1999 and 2004, 125 consecutive patients underwent angiography and intervention for renal salvage and formed the basis of this study. Inclusion criteria for this study included serum creatinine greater than 1.5 mg/dL, ischemic nephropathy, and high-grade RAS perfusing a single functioning kidney. Patients undergoing PTA/S for renovascular hypertension or fibromuscular dysplasia or in conjunction with endovascular stent grafting for aneurysm repair were excluded. The original angiographic imaging was evaluated for lesion grade and parenchymal kidney size. All medical records and noninvasive testing were reviewed. Preoperative and postoperative patient data were standardized and analyzed by using 2 tests for nominal values and t tests for continuous variables. The Modification of Diet in Renal Disease equation was used to estimate glomerular filtration rate (GFR), and univariate analysis was performed. Results: Preoperative variables included the presence of coronary artery disease (93%), diabetes (44%), tobacco use (48%), and hypercholesterolemia (70%). RAS was suspected on the basis of preoperative duplex imaging or magnetic resonance angiography. Aortography and PTA/S were performed in 125 patients (mean age, 71 years; 59% male) with a mean baseline creatinine level of 2.2 mg/dL. There were two mortalities (1.6%) in the 30-day postoperative period, but there was no case of acute renal loss. Blood pressure decreased after PTA/S (151/79 mm Hg before vs 139/72 mm Hg after 1 month; P < .03). For all patients, the estimated GFR went from 33 ؎ 12 mL · min ؊1 · 1.73 m ؊2 (mean ؎ SD) to 37 ؎ 19 mL · min ؊1 · 1.73 m ؊2 at 6 months (P ؍ .10). Sixty-seven percent of treated patients had improvement (>10% increase in GFR) or stabilization of renal function. A rapid decline in GFR before intervention was correlated with improvement after PTA/S. Responders after PTA/S had a 27% decrease in GFR before intervention (44 ؎ 13 mL · min ؊1 · 1.73 m ؊2 to 32 ؎ 13 mL · min ؊1 · 1.73 m ؊2 ; P < .001) with a negative to positive slope change in GFR values. Ten patients underwent reintervention for in-stent restenosis. Cases without improvement in GFR after PTA/S were associated with eventual dialysis need (P ؍ .01; mean follow-up, 19 months). Survival at 3 years was 76%, and dialysis-free survival was 63% as estimated by Kaplan-Meier analyses. Conclusions: Renal artery stenoses causing renal dysfunction can be safely treated via endovascular means. Rapidly decreasing renal function is associated with the response to renal artery angioplasty/stenting and helps identify patients for renal salvage. ( J Vasc Surg 2007;45:101-9.)
Acute Renal Infarction After a Bilateral Aortic-Iliac Stent Thrombosis
Curēus, 2024
A renal infarction occurs when kidney's arterial blood supply is compromised, causing parenchymal necrosis and loss of function. It is a relatively uncommon complication and its treatment is time-dependent. We present a case where a female patient with a history of bilateral aortic-iliac stenting over 10 years before presented with chest pain, palpitations, and dyspnea associated with hypertension. The patient progressed with an acute worsening of renal function and anuria, with an urgent need for renal replacement therapy. The abdominal CT angiography confirmed a complete chronic stent thrombosis and a recent occlusion of the right renal artery causing an acute renal infarction; however, this exam was performed more than 72 hours after admission. There was no longer indication for reperfusion therapy, taking into account the time course. This case reinforces the importance of a thorough clinical history and awareness of risk factors to raise the suspicion of renal infarction that should lead to an early contrast-enhanced CT scan so that adequate therapy can be performed.
Medical Information on Renal Arterial Stenting
Renal artery stenosis (RAS) is a common pathological condition associated with uncontrolled or refractory hypertension, flash pulmonary edema, and worsening renal function. The high prevalence of RAS in patients with coronary and lower extremity vascular disease has been well established. In a recent study on the practice of "drive-by renal shooting", prevalence of significant RAS was found to be high in patients with suspected coronary atherosclerosis referred for coronary angiography. Another study revealed dramatic increase in volume of renal arterial stenting in the Medicare population. Hence, concerns of over-diagnosis and over-treatment of RAS were raised. However, numerous recent studies demonstrated high success rate of renal artery stent revascularization and its clinical benefits. Aggressive screening and early treatment of RAS are therefore warranted in patients with drug-refractory hypertension and/or worsening renal insufficiency. However, some open issues remain. The paper proposes selection criteria for "drive-by renal shooting" and suggests valid criteria for treating RAS.