Isolated spontaneous renal artery dissection: endovascular management.

We report a rare case of isolated spontaneous renal artery dissection treated by stent placement. A 59-year-old man presented with a sudden onset of left flank pain and severe hypertension together with elevated creatinine levels. A computed tomography scan revealed a focal dissection at the left renal artery (LRA) with an infarcted left kidney. Despite medical treatment with 4 drugs, the patient's blood pressure remained uncontrolled. Angiography confirmed the diagnosis. A 6- × 60-mm Xpert stent (Abbott Vascular, Temecula, CA) was deployed at the LRA, achieving an enlarged true lumen with a patent stent. After the procedure, acute renal impairment was observed but pain subsided and blood pressure normalized under the treatment prescribed. At 12 months of follow-up, the patient was normotensive and asymptomatic with mild chronic renal failure and a patent LRA stent on doppler ultrasonography. The endovascular treatment of isolated spontaneous renal artery dissection appears to be feasible and effective and could be the first-line treatment when revascularization is needed.

Endoprótesis aortouniilíaca como alternativa a la cirugía abierta en el remodelado de las endoprótesis de aorta abdominal / Aortouniiliac stent-grafts as an alternative to open surgery in remodelling abdominal aorta stents

Introducción. La incidencia de conversiones tardías quirúrgicas tras endoprótesis de aorta abdominal es del 2.1% anual, y la mortalidad asociada, del 24.4%. Es por tanto deseable ofrecer soluciones endovasculares para disminuir dicha mortalidad. Objetivo. Realizar un estudio retrospectivo de la utilización de la endoprótesis aortouniilíaca para rescatar endoinjertos con gran remodelado, evitando así la conversión a cirugía abierta. Pacientes y métodos. Se revisó una serie de 56 endoprótesis aórticas bifurcadas implantadas por aneurisma de aorta abdominal (AAA) entre los años 1996 y 2000. Resultados. Se hallaron cinco casos de gran remodelado protésico que conllevó conversión a endoprótesis aortouniilíaca y bypass extranatómico. La edad media fue de 73,4 años, y los factores de riesgo más frecuentes, la hipertensión arterial y la cardiopatía isquémica. En todos los casos de conversión, la prótesis previa fue la Vanguard, y los tipos de AAA tratados, B y C. Entre las complicaciones menores hubo un caso de linforrea inguinal, y entre las mayores, una trombosis de endoprótesis y bypass cruzado, rescatados con fibrinólisis. La tomografía computarizada abdominal realizada a los dos años mostró ausencia de fugas y disminución del diámetro del saco aneurismático. No hubo ninguna conversión a cirugía abierta. Conclusiones. La endoprótesis aortouniilíaca asociada a bypass femorofemoral cruzado representa una vía de tratamiento del remodelado protésico grave de menor morbimortalidad que la cirugía abierta. Además, parece disminuir la posibilidad de nuevos remodelados

Introduction. The incidence of late surgical conversions following stent-grafting in the abdominal aorta is 2.1% per year, and the associated mortality rate is 24.4%. Endovascular solutions are therefore needed to reduce this mortality. Aim. To conduct a retrospective study of the use of aortouniiliac stent-grafts to salvage highly remodelled endografts, thus avoiding the need for conversion to open surgery. Patients and methods. We reviewed a series of 56 bifurcated aortic stents implanted due to abdominal aortic aneurysm (AAA) between 1996 and 2000. Results. Results of the review produced five cases of important prosthetic remodelling that entailed conversion to aortouniiliac stent-grafts and extra-anatomical bypasses. Mean age was 73.4 years and the most frequent risk factors were arterial hypertension and ischaemic heart disease. In all the cases of conversion, the previous stent-graft was the Vanguard and the types of AAA that were treated were B and C. Less important complications included one case of inguinal lymphorrhagia and the more complicated cases included a thrombosis of the crossed bypass and stent-graft, which were salvaged using fibrinolysis. Computed tomography scanning of the abdomen performed at two years revealed the absence of leaks and a reduction in the diameter of the aneurysmal sac. There were no conversions to open surgery. Conclusions. Aortouniiliac stent-grafts in association with a femorofemoral crossover bypass represent a way of treating severe stent-graft remodelling with a lower morbidity and mortality rate than open surgery. This technique also seems to reduce the chances of further remodelling being required