A 67-year-old woman with multiple risk factors: hypertension, hypercholesterolemia, dysglycosis, obesity, acute coronary syndrome, etc.

She had a single left kidney with stenosis due to stage 3 chronic kidney disease (K/DOQUI Guidelines) secondary to ischaemic nephropathy with preserved diuresis.

Angiographically, he presented critical stenosis of the left renal artery and uncontrolled hypertension despite drug treatment with quintuple therapy (angiotensin-converting enzyme inhibitors, beta-blockers, calcium antagonists, diuretics and alpha-blockers). Previous tests showed a creatinine level of 1.9-2.4 mg % and a rebellious blood pressure (BP).

Her anaesthetic risk is moderate, and she underwent scheduled surgery to place a stent in the left renal artery under locoregional anaesthesia with continuous blood pressure monitoring. During surgery she is haemodynamically stable, with maintained diuresis.

During the postoperative period, he began with sudden intense pain in the left renal fossa accompanied by hypotension, vegetative symptoms and sudden oligoanuria. Subsequently, he began with chest pain, radiating to the back, with no changes in the electrocardiogram or elevation of cardiac markers. However, treatment for ischaemic heart disease was started. Given the suspicion of stent thrombosis, an arteriography was performed via the left femoral artery confirming renal artery thrombosis (thrombolysis was attempted without success) and migration of the stent, which was unsuccessfully repositioned. During the procedure he was haemodynamically unstable and required vasoactive drugs and blood transfusion; in anuria, with increased urea and creatinine levels, so a dialysis catheter was implanted. He required high doses of vasoactive drugs to maintain BP, haemodiafiltration due to anuria with rising urea and creatinine levels and echocardiography which ruled out cardiogenic component. He presented coagulation alterations with no evidence of active bleeding and rapid clinical deterioration with respiratory failure dependent on mechanical ventilation. Abdominal computed axial tomography showed the presence of a retroperitoneal haematoma, and urgent laparotomy was performed. The situation was complicated by the presence of distributive shock refractory to vasoactive drugs, systemic inflammatory response syndrome and anuric renal failure, and led to a situation of multi-organ failure secondary to complications of vascular surgery on renal ischaemia in a single patient who was finally exhaled, the immediate cause of which was shock refractory to treatment.