A 72-year-old patient was admitted for elective surgery for aneurysm of the infrarenal abdominal aorta and right hypogastric artery. Personal history: right nephrectomy in 1983 for renal cell carcinoma, AHT controlled with amlodipine and old inferolateral AMI with silent heart disease. The DIVAS showed diffuse aortic ectasia and a fusiform aneurysmal dilatation whose neck was 17 mm from the left renal artery, with a 7 mm mural thrombus inside and a maximum lumen size of 35 mm at the level of the inferior mesenteric artery. The aneurysmal dilatation affects both primitive iliac arteries, and a second 13 mm fusiform aneurysm is observed in the right hypogastric artery. Patency of the celiac axis, left renal artery, superior mesenteric artery and occlusion of the inferior mesenteric artery was confirmed.
The patient underwent surgery and an aortic endoprosthesis (Quantum Cordis®) 36-12 with extension to both iliac arteries and embolisation of the right hypogastric artery. The control renal arteriography was normal.
Two hours after the operation, sudden onset anuria was observed, which did not improve with diuretic perfusion. Urgent arteriography (6 h postoperatively) showed total occlusion of the ostium of the left renal artery due to cranial migration of the stent. Urgent revascularisation surgery was decided by means of splenorenal shunt by left posterolateral lumbotomy at the XII rib level. Dissection of the left renal pedicle (1 artery, 1 vein), renal reperfusion by ringer lactate at 4 C and end-to-end anastomosis with the splenic artery (discontinuous stitches of Prolene® 6/0). Reperfusion of the kidney was performed 12 hours after the onset of anuria, with gradual recovery of colour and consistency, maintaining a good pulse at the anastomosis.
Spontaneous diuresis reappeared at 48 h, having previously required a haemodialysis session due to hyperkalaemia and acidosis. The control Angio MRI (2 months) showed the permeability of the stent, the absence of endoleaks and stenosis in the splenorenal anastomosis. At present, the patient continues to have well controlled blood pressure with amlodipine and a creatinine level of 1.4 mg/dl.