Isolated Spontaneous Renal Artery Dissection: A Case Report and Review

Abstract

Spontaneous renal artery dissection (SRAD) is a rare condition and usually presents with nonspecific symptoms. It is thus difficult to diagnose early enough to prevent complications of renal ischemia. SRAD has been associated with several disease processes and situations but a specific causal relationship has not yet been established. There are several treatment options available for SRAD with endovascular treatment being a safe and effective choice. Case PresentationA 65-year-old male patient presented to the emergency room upon request from his ex-wife due to signs of depression, he was tearful and expressed suicidal inclinations. Upon arrival in the emergency room the patient's blood pressure and pulse were 240/150 mm Hg and 105 beats per minute, respectively. He initially denied symptoms of blurry vision, seizures, focal weakness, headache, chest pain, swelling of the lower limbs, syncope, abdominal pain, and hematuria.The patient's medical history was significant for primary hypertension, chronic obstructive pulmonary disease, and obstructive sleep apnea. He had a history of smoking 30-pack per year. His basic metabolic panel showed a normal creatinine. Urine analysis was significant for proteinuria but no hematuria. He was found to have elevated b-type natriuretic peptide in whole blood. Chest X-ray revealed a slightly enlarged heart, and his electrocardiogram showed T-wave inversion in leads V1 and AVL suggestive of ischemia.The patient developed chest pain during hospitalization. A coronary angiogram was performed and revealed a 70 to 80% stenosis of the left anterior descending coronary artery. Percutaneous coronary intervention to the left anterior descending artery was done. Renal artery angiography was also performed during the same session to evaluate for renovascular hypertension. A dissection was discovered in the right renal artery (►Fig. 1).The dissection was verified by intravascular ultrasound assessment. There was no evidence that the dissection was caused by the catheterization procedure, and it was limited only to the right renal artery (►Fig. 2) and a magnetic resonance angiogram (MRA) (►Fig. 3) done before the percutaneous catheterization also showed the dissection in the right renal artery. The dissection was treated with balloon angioplasty and a bare metal stent. Patient's blood pressure preprocedure was 190/ 110 mm Hg and after percutaneous intervention of right renal artery patient's blood pressure was 120/71 mm Hg (►Fig. 4). DiscussionIsolated SRAD is rare with an incidence of only 0.036 to 0.049% of all arterial dissections.1 Renal artery dissections are generally associated with aortic dissection, being involved in 12.4% of all aortic dissections. 2 SRAD is difficult to diagnose and treat early given its nonspecific presentation. Only 200 cases of isolated SRAD have been reported so far and out of those 25% were found during autopsy. AbstractWe report an interesting case of a 65-year-old gentleman who presented with hypertensive emergency and was found to have an isolated spontan...

Kontrastlı çok dedektörlü bilgisayarlı tomografi ile akut spontan izole renal arter diseksiyonunun saptanması

“…This nonspecific presentation often leads delayed diagnose. There are three clinical sequalae of renal artery dissection according to literature; 1) silent with no side effects, 2) renal infarction due to acute renal artery occlusion; 3) chronic, leading to renovascular hypertension [1]. Newonset, uncontrolled hypertension, renal failure resulting from diminished or absent blood flow and infarction of the renal parenchyma are some important complications of renal artery dissection.…”

“…They can be a result of several underlying diseases such as atherosclerosis, malignant hypertension, fibromuscular dysplasia, and connective tissue disorders. Or they can be idiopathic without known of underlying pathology [1]. Nonspecific symptoms such as flank pain or hematuria leads to delay in the diagnosis.…”

Spontaneous renal artery dissection presenting as an aortic dissection: a case report

“…Several cases had endovascular treatment with balloon angioplasty, stenting, or both [5–7]. Other cases involved medical treatment such as antihypertensive medications, pain control, and anticoagulation or antiplatelet agents.…”

Spontaneous Renal Artery Dissection in a Man with Previous Spontaneous Superior Mesenteric Artery Dissection

“…Supportive therapy including control of hypertension and systemic anticoagulation has shown good outcomes, but there is still a risk of acute infarction or renovascular hypertension. Endovascular treatment is a good option because it can prevent both advancement of infarction and renovascular hypertension, and it has become safer as device technology has improved [4]. The potential complications of endovascular treatment are puncture site hematoma, development of dissection, renal artery thrombosis, or perforation.…”