PROXIMAL EXTENSION OF JUXTA-RENAL AORTIC THROMBOSIS: AN UNDERESTIMATED COMPLICATION?
DOI:
https://doi.org/10.48750/acv.348Keywords:
Aorto-iliac occlusive disease, juxta-renal, arterial renal disease, revascularizationAbstract
Aorto-iliac occlusive disease sometimes extends proximally with involvement of the renal arteries and visceral aorta, with loss of renal functional mass and intestinal ischemia. In this article we report the case of a patient presenting with progressive disabling intermittent claudication caused by chronic juxtarenal aortic thrombosis with proximal progression and involvement of the left renal artery, with a functional kidney preserved by the collateral circulation. This imagiologic finding led to a change in the usual surgical procedure, needing a supraceliac aortic clamp. Simultaneously, we choose to revascularize the left renal artery while perfunding the right renal artery with cold Ringer’s lactate solution during clamping period. No complications occurred during the surgery and post-operative period. Renal involvement in aortic juxtarenal thrombosis occurs in 3 to 15% of the cases but demands a more complex surgical approach with more proximal aortic clamping level as well as the use of intraoperative strategies to protect the visceral and renal territories.
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References
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14. Svensson, L. G., Crawford, E. S., Hess, K. R., Coselli, J. S., & Safi, H. J. (1992). Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. Journal of Vascular Surgery, 16(3), 378-390.
15. Allen, B. T., Anderson, C. B., Rubin, B. G., Flye, M. W., Baumann, D. S., Sicard, G. A. (1993). Preservation of renal function in juxtarenal and suprarenal abdominal aortic aneurysm repair. Journal of Vascular Surgery, 17(5), 948-959.
16. Svensson, L. G., Coselli, J. S., Safi, H. J., Hess, K. R., & Crawford, E. S. (1989). Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. Journal of Vascular Surgery, 10(3), 230-239.
17. Coselli, J. S. (2010). Strategies for renal and visceral protection in thoracoabdominal aortic surgery. In https://core.ac.uk/download/pdf/82041469.pdf accessed in 31 August 2020.
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19. Hirose, T., Sawabata, N., Abe, T., Hayata, Y., Hiraga, S., Nishikawa, H., Taniguchi, S. (2020). Protective Effects of Cold Ringer's Solution Perfusion in Abdominal Aortic Surgery Requiring Renal Artery Clamp. in vivo, 34(2), 739-744.
20. Tshomba, Y., Kahlberg, A., Melissano, G., Coppi, G., Marone, E., Ferrari, D., Chiesa, R. (2014). Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery, 59(3), 623-633.
2. Starrett, R. W., & Stoney, R. J. (1974). Juxtarenal aortic occlusion. Surgery, 76(6), 890-897.
3. Madiba, T. E., & Robbs, J. V. (1993). Aortofemoral bypass in the presence of total juxtarenal aortic occlusion. European Journal of Vascular and Endovascular Surgery, 7(1), 77-81.
4. Reilly, L. M., Sauer, L., Weinstein, E. S., Ehrenfeld, W. K., Goldstone, J., Stoney, R. J. (1990). Infrarenal aortic occlusion: does it threaten renal perfusion or function?. Journal of Vascular Surgery, 11(2), 216-225.
5. Erskine, J. M., Gerbode, F. L., French, S. 3., & Hood, R. M. (1959). Surgical Treatment of Thrombotic Occlusion of Aorta and Iliac Arteries: The Leriche Syndrome. AMA archives of surgery, 79(1), 85-93.
6. Rob, C. G. (1960). Chronic occlusive disease of the aorta and iliac arteries (treatment and results). J. Cardiovasc. Surg., 1, 57.
7. Yune, H. Y., Klatte, E. C. (1976). Collateral circulation to an ischemic kidney. Radiology, 119(3), 539-546.
8. a Gama, A. D., Nunes, J. S., & Pedro, L. M. (2003). Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft. Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular, 10(3), 141.
9. Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., Rosenfield, K. A. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines. Circulation, 113(11), e463-e654.
10. Bax, L., Woittiez, A. J. J., Kouwenberg, H. J., Mali, W. P., Buskens, E., Beek, F. J., et al. (2009). Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Annals of internal medicine, 150(12), 840-848.
11. Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. (2009). Revascularization versus medical therapy for renal-artery stenosis. New England Journal of Medicine, 361(20), 1953-1962.
12. Bavry, A. A., Kapadia, S. R., Bhatt, D. L., Kumbhani, D. J. (2014). Renal artery revascularization: updated meta-analysis with the CORAL trial. JAMA internal medicine, 174(11), 1849-1851.
13. Dean, R. H., Englund, R., Dupont, W. D., Meacham, P. W., Plummer, W. D., Jr, Pierce, R., Ezell, C. (1985). Retrieval of renal function by revascularization. Study of preoperative outcome predictors. Annals of surgery, 202(3), 367–375.
14. Svensson, L. G., Crawford, E. S., Hess, K. R., Coselli, J. S., & Safi, H. J. (1992). Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. Journal of Vascular Surgery, 16(3), 378-390.
15. Allen, B. T., Anderson, C. B., Rubin, B. G., Flye, M. W., Baumann, D. S., Sicard, G. A. (1993). Preservation of renal function in juxtarenal and suprarenal abdominal aortic aneurysm repair. Journal of Vascular Surgery, 17(5), 948-959.
16. Svensson, L. G., Coselli, J. S., Safi, H. J., Hess, K. R., & Crawford, E. S. (1989). Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. Journal of Vascular Surgery, 10(3), 230-239.
17. Coselli, J. S. (2010). Strategies for renal and visceral protection in thoracoabdominal aortic surgery. In https://core.ac.uk/download/pdf/82041469.pdf accessed in 31 August 2020.
18. Crutchley, T. A., Pearce, J. D., Craven, T. E., Edwards, M. S., Dean, R. H., Hansen, K. J. (2007). Branch renal artery repair with cold perfusion protection. Journal of Vascular Surgery, 46(3), 405-412.
19. Hirose, T., Sawabata, N., Abe, T., Hayata, Y., Hiraga, S., Nishikawa, H., Taniguchi, S. (2020). Protective Effects of Cold Ringer's Solution Perfusion in Abdominal Aortic Surgery Requiring Renal Artery Clamp. in vivo, 34(2), 739-744.
20. Tshomba, Y., Kahlberg, A., Melissano, G., Coppi, G., Marone, E., Ferrari, D., Chiesa, R. (2014). Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery, 59(3), 623-633.
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Published
2021-03-05
How to Cite
1.
Henriques M, Ministro A, Silva E, Pinto V, Rato J, Mendes Pedro L. PROXIMAL EXTENSION OF JUXTA-RENAL AORTIC THROMBOSIS: AN UNDERESTIMATED COMPLICATION?. Angiol Cir Vasc [Internet]. 2021 Mar. 5 [cited 2024 Nov. 23];16(4):314-7. Available from: https://acvjournal.com/index.php/acv/article/view/348
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Clinical Case
