Among these complications are
renal artery stenosis,
renal artery thrombosis, renal vein thrombosis, arteriovenous fistula, and
renal artery aneurysm.
Type II--Inferior segmental branch arises from the posterior division of
renal artery.
In one patient, during deployment the flow diverter, stent's proximal part protruded into the main
renal artery compromising the anterior branch.
Renal vein thrombosis and
renal artery occlusion usually result in graft loss, but fortunately are rare complications.
Reformatted coronal abdominal MRA images demonstrating the stenotic segment of the left
renal artery and abdominal aorta (arrows).
(2-3) A systematic review revealed only 14 cases of arterioenteric fistula from the
renal artery following previous grafting and surgery, however with a near 43% reported mortality, and highlights that the clinician must have a high degree of suspicion to pursue diagnosis and therapy rapidly if the patient is to survive.
Percutaneous
renal artery stent placement is considered a safe procedure with the risk of complications being 5-15%.3,4 Common complications include groin haematoma at the puncture site, branch vessel occlusion, and
renal artery dissection.
We decided to use LDSITT for the occluded
renal artery branches because the patient was not eligible for percutaneous therapy.
After proximal and distal control was obtained, the saccular aneurysmal wall was resected and the
renal artery was repaired primarily.
Two large-scale randomized controlled clinical trials (RCTs), ASTRAL (Angioplasty and Stent for
Renal Artery Lesions) trial [7], and CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trial [8] compared PTRA and conventional medication therapy regarding outcomes for BP lowering effects, renal protection (in ASTRAL), and onset of future cardiovascular events (in CORAL).
However, the reliability of catheter-based RDN is uncertain, because the renal sympathetic nerves are mainly distributed in the adventitial surface of the
renal artery [8, 9].
Patient age, antero-posterior (AP) abdominal aortic diameter and longitudinal diameter (length) were quantitative variables while aneurysmal sac form, wall calcification, involvement of
renal artery and peri-aortic haematoma were qualitative variables.
