Presentation
Hypertension. Occlusion of the distal abdominal aorta, both common iliac arteries and right renal artery. Critical stenosis of the left renal artery with renal impairment (creatinine 300, eGFR 18 mL/min) prior to stenting. Stenting of the left renal artery performed, bypass graft of the occluded aorta planned.
Patient Data
The aorta at the celiac axis origin is distended with plaque. A channel supplying the celiac axis remains. Markedly elevated velocities within the proximal celiac axis suggest a >70% stenosis. The superior mesenteric artery was patent and no stenosis was detected (not shown). The aorta at the level of the superior mesenteric artery is also distended with plaque and a channel supplying the SMA remains. Occlusion of the distal aorta was noted (spectral analysis not shown).
The left renal artery origin and stent are identified. Velocities remained within normal limits along the entire length of the stent. The entire left renal artery was examined with spectral Doppler. Waveforms and velocities were normal. Left renal artery waveforms were normal at the hilum of the left kidney. The left kidney appeared morphologically normal.
Occlusion of the right renal artery was noted (spectral analysis not shown). The right kidney appeared morphologically normal. Perfusion of the right kidney could not be demonstrated but was noted on a CT-A 2 months previously. No flow was demonstrated in the right renal vein, which was not distended.
Case Discussion
The narrower caliber of the stent will produce generally higher velocities than a normal renal artery.
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