Article Text
Summary
Renal Artery Stenosis (RAS) is an important cause of treatment-resistant hypertension. Uncontrolled hypertension with RAS can cause progressive chronic kidney disease (CKD) leading to end-stage kidney disease. Therapeutic revascularisation can be helpful in appropriate circumstances where pharmaceutical intervention has failed and significant renovascular disease contributes to resistant hypertension. We present an interesting case of a Caucasian male with peripheral vasculopathy, abdominal aortic aneurysm (AAA), single functioning kidney and ostial RAS caused by stent struts from an endovascular AAA stent graft. He had escalating medications requirement, with repeated failed attempts at percutaneous radiological intervention that led to an episode of contrast-induced acute kidney injury (AKI), before undergoing successful surgical revascularisation by a splenic artery transposition graft to the left renal artery that was performed to improve kidney function and the blood pressure. This report highlights the challenges faced with regard to the management of severe hypertension and progressive CKD.
- abdominal aortic aneurysm
- chronic kidney disease
- resistant hypertension
- renal artery stenosis
- splenic artery bypass graft
- stent graft
- revascularisation
- peripheral vascular disease
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Footnotes
Contributors SS prepared, edited and researched the manuscript and managed the care of the patient. RJS edited and researched the manuscript and managed the care of the patient. EC operated on the patient and is involved in the editing of the manuscript. FEH managed the patient, edited and researched the manuscript. PS managed the care of the patient, edited and researched the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.