Successful Reversal of Acute Kidney Failure by Ultrasound-Accelerated Thrombolysis of an Occluded Renal Artery

Abstract

Purpose. To describe the treatment of renal artery thrombosis with ultrasound-accelerated thrombolysis and discuss the management of prolonged renal ischemia. Case. A 76-year-old patient with a single functional kidney, mild chronic renal impairment, and a recent history of endovascular repair of a thoracoabdominal aneurysm with an aortic branch graft presented with acute flank pain, anuria, and renal failure. The side branch from the aortic stent graft to his single, right, functional kidney appeared to be completely thrombosed. Symptoms had started after cessation of oral anticoagulants because of a planned mastectomy for breast cancer. After identification of the occlusion, ultrasound-accelerated thrombolysis was started 19 hours after the onset of anuria. Angiography, 4 hours after beginning of therapy, already showed partial dissolution of the thrombus and angiographic control after 18 hours showed complete patency of the renal artery side branch. Despite a long period of ischemia, renal function was completely recovered. Conclusion. In patients with acute renal ischemia due to thrombosis of the renal artery, complete recovery of function can be achieved with ultrasound-accelerated thrombolysis, even after prolonged periods of ischemia.

Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching

“…Furthermore, no recommendation exists on how long after the occlusion a treatment attempt should be done and whether only patients with a solitary kidney and bilateral occlusion should be treated. The current literature [7][8][9][10][11][12][13][14][15][16][17][22][23][24][25][26][27][28] on renal function salvage after delayed treatment mainly consists of case reports and very small series. Considering the low evidence in the field, decision-making is not always easy.…”

“…Regarding the lack of evidence for open or interventional treatment of RAO, only a few case reports and small series have reported on renal function salvage after delayed revascularization. [7][8][9][10][11][12][13][14][15][16][17] Herein is presented a singlecenter experience with acute RAO and delayed renal artery revascularization after fenestrated-branched EVAR or open visceral debranching.…”

Acute Renal Artery Embolism: A Case Report and Literature Review

“…Intra-arterial thrombolytic therapy has been applied to treat RAE. Based on angiographic images, thrombolytic therapy demonstrated a better chance of patency in cases of RAE than anticoagulants [7,21,22]. However, when compared to anticoagulants, the overall improvement of renal function, morbidity and mortality of RAE patients is not prominent [6,14,17].…”

“…In addition, the management of RAE depends greatly on the capability of a given hospital. Few centers are capable of performing emergent intravascular interventions [21,22]; other hospitals are capable of only surgical or pharmacologic therapies. Different methods of RAE management further impair the comparison of the benefits of different therapies.…”

Renal salvage using stent graft placement after acute renal artery occlusion with prolonged ischemic time

“…There are limited case reports on the treatment of acute RAO. 6 Traditional recommendation is early intervention after diagnosis of RAO; however, the time cutoff for intervention is poorly understood and is variable depending on the cause of the occlusion (embolic versus thrombotic). 2 Therapeutic options include management with anticoagulation, thrombolytics, and surgical thrombectomy or catheter-based treatments.…”