Hepatorenal and Splenorenal Artery Bypass for Salvage of Renal Function

Rigdon, Edward E.; Durham, Joseph R.; Massop, Douglas W.; Wright, Jonathan; Smead, William L.

doi:10.1007/bf02016745

Cited by 13 publications

(6 citation statements)

References 14 publications

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“…Eight patients with ARAS and azotemia were treated with six hepatorenal and five splenorenal artery bypasses. SCr improved in all patients but only four of the five patients with severe hypertension had improved BP outcomes 14. Splenorenal bypass is associated with a high risk of splenic and pancreatic injury while trying to expose the splenic artery.…”

Section: Discussionmentioning

confidence: 88%

Spleno-renal artery transposition in a solitary functioning kidney for treatment-resistant hypertension and acute kidney injury

Somalanka¹,

Harris

Chemla

et al. 2017

BMJ Case Reports

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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.

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Section: Discussionmentioning

confidence: 88%

Spleno-renal artery transposition in a solitary functioning kidney for treatment-resistant hypertension and acute kidney injury

Somalanka¹,

Harris

Chemla

et al. 2017

BMJ Case Reports

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“…If the celiac artery is not patent, hepatorenal bypass and splenorenal bypass are not suitable as they can lead to infarction of the liver and spleen, respectively [2]. Furthermore, hepatorenal bypass is contraindicated when the patient has liver dysfunction, and splenorenal bypass requires a great exposure and is associated with a risk of splenic and pancreatic injuries [4]. Both ileorenal bypass and kidney AutoTx are not suitable when severe iliac arterial atherosclerosis is present.…”

Section: Discussionmentioning

confidence: 99%

“…Although PTRA is less invasive, in-stent restenosis remains a frequently encountered problem, reaching 20% at 1 year after PTRA [3]. Open hepatosplenorenal bypass can contribute to long-term bypass patency; however, it is invasive and can cause liver and spleen injury or infarction [4]. In contrast, the usefulness and safety of kidney autotransplantation (AutoTx) as a treatment for renal artery stenosis after PTRA have only been rarely reported [5].…”

Section: Introductionmentioning

confidence: 99%

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

et al. 2019

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Background Unintentional renal artery occlusion after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains one of the most unfavorable complications. Renal salvage options include percutaneous transluminal renal artery angioplasty (PTRA) and open hepatosplenorenal bypass. However, the usefulness of kidney autotransplantation (AutoTx) remains unclear. Case presentation A 76-year-old woman with a right solitary kidney attributable to a left renal thromboembolism had previously undergone EVAR with a stent graft for an infrarenal aortic aneurysm, which led to ostial occlusion of the right renal artery. In addition, she had undergone PTRA and stenting. Two days before admission, she developed leg edema and hypertension, leading her to visit the hospital. Her serum creatinine level was 2.4 (baseline, 1.0) mg/dL. Acute kidney injury due to renal artery in-stent restenosis was suspected; re-angioplasty was attempted on day 2 of hospitalization, but was unsuccessful. Her renal function did not improve and anuria persisted; thus, hemodialysis was initiated on the same day. The right kidney size (8.6 cm) was preserved relative to her body size, with only mild cortical atrophy. Doppler ultrasonography and mercaptoacetyltriglycine scintigraphy revealed minimal but significant perfusion of the right kidney. Therefore, we considered that kidney perfusion was sustained and renal function could be reversed. On day 25 of hospitalization, right kidney AutoTx to the right iliac fossa was performed to reestablish adequate renal perfusion and reverse the need for dialysis. Soon after the procedure, the patient started passing urine. Her renal function improved; her serum creatinine level decreased to 1.0 mg/dL on day 33 of hospitalization. Hemodialysis was discontinued after the surgery. Zero-hour kidney biopsy showed only mild tubular injury, with neither tubular necrosis nor glomerular abnormalities. Conclusions Kidney AutoTx can be performed for patients with renal artery in-stent occlusion after unsuccessful PTRA who previously underwent EVAR. Our case showed successful recovery of renal function nearly 1 month after renal artery occlusion, indicating that revascularization should be considered even if it is delayed, as the kidney might be perfused through collateral circulation.

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“…1 This traditionally and most often was employed to treat renovascular hypertension secondary to renal artery stenosis. [1][2][3] It also was employed, after both blunt and penetrating trauma to the abdomen, as a salvage procedure to preserve renal function. Other reported applications included treatment of bilateral renal artery injury if only one kidney was present, repair of a solitary arterial injury by simple lateral arteriorrhaphy, 4 and correction of a renal artery rupture during percutaneous transluminal angioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…5 Splenorenal arterial bypass may be an advantageous alternative for renal revascularization, particularly, in patients with an aorta that precludes an aortorenal bypass. 2 Such patients include those whose cardiac dysfunction might be exacerbated by aortic clamping, those who have undergone previous aortic graft placement, 3 and those with severely atherosclerotic aortic walls.…”

Section: Discussionmentioning

confidence: 99%

Splenorenal Arterial Bypass: Description of Technique and Case Example in an Instance of Renal Revascularization during Adrenalectomy for Adrenocortical Carcinoma

Yozawitz¹,

Kissin²,

Szuchmacher³

et al. 2015

Int J Angiol

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We present a patient with a 16 cm adrenocortical carcinoma that underwent a left adrenalectomy en bloc with resection of the involved segment of the left renal artery. A splenectomy and splenorenal bypass was performed to revascularize the left kidney. To our knowledge, this is the first instance in the literature of a splenorenal arterial bypass being reported for renal revascularization during an extirpative oncologic procedure. A 64-year-old male patient, with history significant for adrenocortical carcinoma, status post prior right adrenalectomy with partial right nephrectomy, presented for an elective left adrenalectomy. Preoperative work-up revealed an 11.4 × 13.2 × 16 cm left adrenal mass, most consistent with an adrenocortical carcinoma. At the time of surgery, the mass was found to be intimately adherent to the aorta at the takeoff of the left renal artery. Moreover, the left renal artery appeared to be coursing directly through the mass. The involved segment of the left renal artery was resected en bloc with the tumor. Because of concerns for a small and likely poorly functioning right renal remnant, a decision was made to attempt to salvage the left kidney. This was accomplished by performing a splenectomy and constructing a splenorenal bypass. Serial Duplex Doppler renal ultrasound studies were obtained over the first three postoperative days and demonstrated improved arterial waveforms. Serum creatinine reached a peak level of 3.76 mg/dL on postoperative day 3, and then began to slowly trend down to 3.37 mg/dL on the day of discharge (postoperative day7).

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Hepatorenal and Splenorenal Artery Bypass for Salvage of Renal Function

Cited by 13 publications

References 14 publications

Spleno-renal artery transposition in a solitary functioning kidney for treatment-resistant hypertension and acute kidney injury

Spleno-renal artery transposition in a solitary functioning kidney for treatment-resistant hypertension and acute kidney injury

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

Splenorenal Arterial Bypass: Description of Technique and Case Example in an Instance of Renal Revascularization during Adrenalectomy for Adrenocortical Carcinoma

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