Revascularization for Acute Renal Failure — A Case Report

Abstract

An interesting case of aortorenal bypass allowing discontinuation of renal dialysis is presented, along with a brief review of the literature. Case ReportA fifty-six-year-old white male was admitted with pulmonary edema. History included myocardial infarction three years prior to admission, hypertension treated for ten years, and diabetes mellitus requiring insulin for eighteen months. Renal failure was identified by an elevated BUN (156 mg/dl) and serum creatinine (13.2 mg/dl). The patient was begun on hemodialysis with consequent reduction of serum creatinine to 6.4 mg/dl. Renal ultrasonography gave normal findings. Percutaneous needle biopsy of the kidney revealed nonspecific changes of acute renal failure without widespread glomerular hyalinization. Abdominal aortography demonstrated bilateral total renal artery occlusions. There was very diminished opacification of the renal circulation from lumbar arterial collateral sources (Fig. 1). The right renal artery was occluded over a 2-cm length to its primary bifurcation. On the left the occlusion was less than 1 cm and was thought to be secondary to mural aortic plaque. The abdominal aorta was severely atherosclerotic with ulceration extending into the iliac system. The patient underwent bilateral aortoiliac and bilateral saphenous aortorenal bypass. Aortorenal anastomoses were end-side. Renal dialysis was required on two occasions after surgery but was discontinued by the eighth postoperative day. Serum creatinine was 3.1 mg/dl on discharge, with further declines to 1.7 two weeks later and to 1.4 at two months. The postoperative course to seventeen months has been uneventful.