Abstract: FR-PO542
Perils of Renal Revascularization for Severe Hypertension
Session Information
- Dialysis and Vascular Trainee Case Reports
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Sriperumbuduri, Sriram, The Ottawa Hospital, Ottawa, Ontario, Canada
- Hiremath, Swapnil, University of Ottawa, Ottawa, Ontario, Canada
- Ruzicka, Marcel, University of Ottawa, Canada, Ottawa, Ontario, Canada
Introduction
Revascularization is not superior to medical therapy in atherosclerotic renal artery stenosis (RAS). This may be partly attributed to renal complications from revascularization but also from extra renal complications due to the drop in systemic blood pressure (BP). We highlight this with a case of a man who developed an extrarenal complication following renal angioplasty.
Case Description
A 58 year old man was referred to the hypertension clinic at a tertiary care hospital.He was on 5 BP lowering drugs with a 5-minute office resting BP of 213/99 mm Hg. Magnetic resonance angiogram showed extensive atherosclerotic disease of the aorta and branches including bilateral (B/L) RAS, 80 % on right and 50% on left. In view of this and resistant hypertension, he underwent B/L renal angioplasty and stenting. Post intervention BP in the clinic was 123/89 mmHg despite a 50% decrease in BP medications. On day 3, he developed diffuse, progressively worse abdominal pain, along with nausea and vomiting. Laboratory tests showed leukocytosis and elevated lactate. Computed tomography scan confirmed diagnosis of subacute mesenteric ischemia due to superior mesenteric artery (SMA) occlusion and progressive stenosis of celiac trunk. He underwent stenting and angioplasty of the latter which resolved his symptoms. At 1 month, his BP was 106/68 on 3 drugs.
Discussion
Renal artery stenting for drug resistant hypertension improved this patient's BP. However, the decrease in systemic BP made the hitherto non-critical stenoses of aortic branches clinically critical, thus precipitating bowel ischemia.This highlights some of the mechanisms behind the morbidity associated with renal revascularization. Our data also suggests that critical review and awareness of the extent of extrarenal atherosclerosis prior to renal angioplasty may prevent or at least hasten the diagnosis of post-revascularization complications.
Upper panel-renal artery stenting
Lower panel-stenosis in celiac artery(left),SMA(right)