Abstract: SA-PO0367
The Hidden Cost of Holding Aspirin: Bilateral Renal Artery Thrombosis in a Patient After Branched Thoracic Endovascular Aortic Repair
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Tran, Jacky Vinh, Washington State University, Everett, Washington, United States
- Juaire, Noemie C., Snohomish Kidney Institute, Everett, Washington, United States
Introduction
Bilateral renal artery in-stent thrombosis is an exceedingly rare and potentially catastrophic cause of acute anuric renal failure. While early stent thrombosis following endovascular aortic repair has been described, delayed thrombosis triggered by pre-operative antiplatelet cessation in the setting of an unrelated elective surgery has not been previously reported. We present a case of acute anuric renal failure in a patient who developed bilateral renal artery in-stent thrombosis following aspirin hold for elective parathyroidectomy, occurring six months after branched thoracic endovascular aortic repair (BTEVAR) with bilateral renal artery stent placement.
Case Description
A 73-year-old male with hypertension, hyperlipidemia, and prior BTEVAR with bilateral renal artery stenting presented with sudden-onset complete anuria six days after elective parathyroidectomy for primary hyperparathyroidism. He had no prior chronic kidney disease. Aspirin had been held two weeks preoperatively per standard protocol. Labs revealed acute kidney injury with markedly elevated creatinine from a normal baseline. Urgent renal duplex demonstrated bilateral renal artery graft thrombosis with reduced flow (L>R). Renal replacement therapy was initiated. Following multidisciplinary nephrology and vascular surgery evaluation, anticoagulation was started and the patient was transferred to a tertiary center for urgent bilateral renal stent suction thrombectomy, angiography, and right femoral endarterectomy with bovine pericardium repair.
Discussion
Renal artery stents placed during complex endovascular aortic repair carry ongoing thrombotic risk, mitigated by antiplatelet therapy. Here, a brief preoperative aspirin hold — compounded by surgical stress, hemodynamic shifts, and an existing stent substrate — appears sufficient to precipitate simultaneous bilateral in-stent occlusion. This combination of prior BTEVAR with bilateral renal stents, aspirin cessation, and elective non-vascular surgery represents a previously unreported precipitant. Renal artery stents, in this context, must be considered functionally equivalent to coronary stents perioperatively. Urgent imaging is essential and needs to be considered in any patient with prior renal stenting who develops postoperative anuria.