PMC7448260_01
(a,b) Coronal and axial CT scan views demonstrating occlusion of the pararenal and infrarenal aorta and common iliac arteries. The proximal renal arteries are occluded bilaterally. The blue arrow points to previously placed left renal stent that is now thrombosed. There is flow in the right renal artery and branches of the left renal artery (yellow arrows). The left kidney is edematous and without enhancement. There is cortical enhancement in the right kidney.
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A computed tomography angiography (CTA) on 11 December 2017 demonstrated a chronic aortic occlusion along with bilateral proximal RAO that reconstituted to the mid to distal renal arteries via collateralization from the middle supra-renal/capsular arteries (Figure 1).
(a) Pre-intervention angiogram of the left kidney showing prior stent encroaching on the renal artery bifurcation. Cortical opacification was noted only once mid-renal artery was injected. (b) Post-intervention angiogram showing restoration of renal artery flow accomplished after angioplasty and the additional placement of a Gore VBX stent graft (6 mm x 39 mm). Improvement of cortical enhancement is noted.
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On the left, the prior stent encroached on the renal artery bifurcation with the proximal end flared using an 8 mm balloon (Figure 2).
(a) Pre-intervention angiogram demonstrating robust right distal renal artery. Selective catheterization of right renal artery with intraluminal access confirmed. The distal renal artery was of good quality. (b) Post-intervention angiogram demonstrating restoration of flow throughout the renal artery and improvement of the cortical enhancement.
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For the right renal artery, we were able to deploy a stent-graft across the occluded segment, achieving good flow at the end without any significant stenosis (Figure 3).
The patient's creatinine and glomerular filtration rate (GFR) on day stent placement were 11.48 and 5.0, respectively, and were 5.53 and 11.0 on the day of discharge. At the five months follow-up, they improved to 2.63 and 25.
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The patient's Cr and glomerular filtration rate on day stent placement were 11.48 and 5, respectively, and were 5.53 and 11 on day of discharge, and at the five months follow-up, they improve to 2.63 and 25 (Figure 4).