Renal intra-arterial heparin flushing for blood pressure control in refractory hypertension: A new method to salvage the unsalvageable renal artery stenosis

Refractory hypertension is a type of hypertension that requires special attention. Secondary causes of hypertension should be considered when uncontrolled blood pressure is present, especially in younger patients (<30 years). In this case, the presence of bilateral renal artery stenosis resulted in refractory hypertension and end-stage renal disease requiring renal replacement therapy in the form of hemodialysis. The main challenges will be discussed in this case is to deliver the most beneficial therapy considering the very limited option for revascularization therapy because of the late presentation of patient's condition. Intra-arterial heparin flushing was chosen for this patient to consider the advantages over the risks arising from the actions taken.