Obstructive Uropathy Caused by Atherosclerotic Abdominal Aortic Aneurysm

Abstract

A 77-year-old man with hypertension presented with left flank pain for 1 day. He was initially treated as renal colic. Due to worsening of the clinical symptoms and deteriorated renal function, a computed tomography (CT) scan was obtained which demonstrated a huge infrarenal atherosclerotic abdominal aortic aneurysm (AAA) (about 8.3 cm in diameter) with lateral displacement and direct extrinsic compression of the left ureter (Picture 1), causing left hydronephrosis and hydroureter (Picture 2). After endovascular aneurysm repair, he had an uneventful recovery. Follow-up studies at 16 months showed a gradual decrease of the aneurysm sac, and complete resolution of the left obstructive uropathy.An AAA should be considered among the causes of obstructive uropathy. Most case reports are secondary to dense peri-aneurysmal fibrosis complicating inflammatory AAA, causing entrapment of the ureter within the aortic wall (1, 2). Atherosclerotic AAA rarely cause ureteral obstruction and lateral displacement of the ureter is a characteristic urographic finding (2).

Renal failure caused by a partly calcified aortic aneurysm in a patient with dabigatran therapy

“…This could lead to nutcracker-syndrome or obstructive uropathy. [3,4] In our case, the AAA with its thrombotic and calcified deposits led to a decreased perfusion of the kidneys and therefore to renal failure. Creatinine levels and creatinine clearance were normal when the patient underwent the pacemaker implantation 3 years ago and in the last pacemaker control 1 year ago.…”