Acute renal failure following endovascular repair of an infrarenal abdominal aortic aneurysm

Departments of 1Nephrology and 2Interventional Radiology, Hospital Clinico Universitario San Carlos, Madrid, Spain Endovascular repair of an abdominal aortic aneurysm (AAA) is today a widely accepted alternative to conventional open surgical treatment, especially in patients with a high risk of complications [1]. We describe a case of acute renal failure following the implantation of an endograft in a patient with infrarenal AAA and only one functioning kidney. The patient was a 73-year-old man diagnosed with an infrarenal AAA very close to the right renal artery and an atrophied left kidney. We implanted a bifurcated Talent endograft (World Medical/Medtronic/AVE, Santa Rosa, CA). The procedure was uneventful but, a few hours later, the patient underwent anuric acute renal failure requiring haemodialysis. The patient was subjected to further arteriography 16 days after endovascular repair (Figure 1), in which the right renal artery was seen to be completely occluded by the the stent and a faint intrarenal vascular tree fed by the right suprarenal artery. Open surgery was performed 22 days later, in which an internal saphenous vein bypass from the common hepatic artery to the right renal artery was undertaken. The biopsy showed acute tubular necrosis. Afterwards, renal function improved. Magnetic resonance angiography follow-ups showed the good condition of the aortic endograft and patency of the hepatorenal bypass (Figure 2). A year later, the patient showed a plasma creatinine of 1.9 mg/dl.