LericheSendromu Olan BirHastadaHipertansiyonunVeKronikBöbrekHastalığınınBrakialArterdenPerkütanGirişimYapılarakTedaviEdilmesi
Treatment of Hypertension and Chronic Kidney Disease by Percutaneous Intervention via Brachial Artery in Patient with Leriche Syndrome
Renal artery stenosis is a rare but important cause of secondary hypertension. When severe stenosisprogresses to occlusion, this may result in aggravationof previously controlled hypertension and elevation ofserum creatinine.For this reason, invasive procedures must be performed to improve blood pressure and renal function. In our patient with Leriche syndrome, percutaneous stent implantation for renal artery stenosis was successfully performed via brachial artery to normalize blood pressure and renal function. Atherosclerosis occurs not only in coronary and cerebral arteries, but alsoin the aorta and in its main branches.Renal artery stenosis is an important, potentially correctable cause of secondary hypertension and chronic kidney disease. The prevalence is much higher in patients with acute, severe, or refractory hypertension. Leriche syndrome, also referred to asaortoiliac occlusivedisease, results from thrombotic occlusion of the abdominalaortaimmediately above the site of its bifurcation. The syndrome typically begins at the distalaorta orcommon iliac artery origins and slowly progresses proximallyand distally over time, rarely affecting the visceralor renal arteries. In this report, we summarized a case that has intractablehypertension, renal dysfunction due to aortoiliac occlusivedisease. Percutaneous stent implantation for renal artery stenosis was successfully performed via brachial artery to reverse renal function and to normalize blood pressure.
51 year-old male was admitted to our hospital with resistant high blood pressure. Physical examination revealed a blood pressure of 230/120 mmHg despite high dose anti-hypertensive drug combination. In hospital course, his creatinine level increased up to 2.7 mg/dl. Doppler ultrasonography detected atrophic left kidney, normal size of right kidney and findings that were compatible with critical renal artery stenosis. Magnetic resonance angiography (MRA)demonstrated total occlusion of abdominal aorta and left renal artery and severe right renal artery stenosis (figure, part A). A brachial artery approach was usedafter reviewing the MRA in our case. Aortographywas performed first to check thegeneral condition ofthe abdominal aorta and the renal arteries. A stenosis of greater than 95% was confirmed with selective right renalangiography (figure, part B). A left amplatz guiding catheter was used and percutaneous intervention was carried out at the same time using a balloon-expandable stent (7,0x18 mm,invatec-scuba)after placement of emboshield for distal embolization (figure, part C). In the hospital course, his creatinine level decreased nearly normal range (1.3 mg/dl) and a dramatic drop in blood pressure wasobserved the next few days without any anti-hypertensive drugs.
Figure legends:
A. Magnetic resonance angiography showed total occlusion of abdominal aorta and left renal artery and severe right renal artery stenosis
B. A stenosis of greater than 95% was confirmed with selective right renal angiography. Baloon expandable stent was advanced to the appropriate area and released
C. After stent placement, control angiography showed a good result