Post-stenotic renal artery dilatation – the smoking gun of a case of renal fibromuscular dysplasia induced secondary hypertension
DOI:
https://doi.org/10.48750/acv.712Keywords:
Renal artery obstruction, Fibromuscular dysplasia, Renovascular hypertension, Renal angioplastyAbstract
INTRODUCTION: Renal artery stenosis is a leading cause of secondary hypertension, with atherosclerosis and fibromuscular dysplasia as the main causes.
CASE REPORT: A 41-year-old male developed progressive worsening of high blood pressure over the previous 5 years, along with erythrocytosis, despite compliance with dual antihypertensive therapy. Duplex ultrasound suggested the presence of a right renal artery stenosis. Subsequent tomography angiography (CTA) failed to report a significant stenosis. However, upon imaging reappraisal, the presence of a mid-section dilatation in the right renal artery was noted. Digital subtraction angiography confirmed the dilatation between 2 focal stenoses, which were not identifiable on CTA, suggestive of fibromuscular dysplasia. A translesional pressure gradient of 107mmHg107mmHg was determined. Renal artery stenting was performed with a 7×27mm7×27mm covered stent with good angiographic result. Nine months after intervention, blood pressure normalized, and antihypertensive medications were withdrawn.
CONCLUSION: High clinical suspicion was key to adequately diagnose and manage this case of renovascular secondary hypertension.
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