Journal of Vascular and Endovascular Therapy

Inferior Mesenteric Artery as an Inflow for Unilateral Renal Artery Revascularization

Introduction: To report a successful unilateral renal revascularization via an inferior mesenteric artery to left renal artery bypass with return of renal function to baseline postoperatively.

Methods: A 73-year-old female presented with rapidly deteriorating renal function and uncontrolled hypertension secondary to ischemic nephropathy due to chronic renovascular occlusive disease. The patient had failed prior Percutaneous Transluminal Angioplasty (PTA) attempts. Preoperative evaluation showed the right kidney to be atrophied and normal size left kidney. Intraoperative exploration revealed porcelain abdominal aorta and both common and external iliac arteries were heavily calcified and were not suitable for appropriate clamping or to be used as an inflow for renal revascularization. Although the patient was asymptomatic, both celiac artery and Superior Mesenteric Artery (SMA) were nearly occluded and severely stenosed, respectively, at their origins. Therefore, the splenic artery and SMA were not used for reconstruction. Further exploration revealed a minimally diseased and widely patent Inferior Mesenteric Artery (IMA). A unilateral renal revascularization was performed via an IMA to left renal artery bypass using PTFE graft via a midline laparotomy.

Results: The patient was discharged on postoperative day 8 in good condition. Glomerular Filtration Rate (GFR) and blood pressure returned to baseline within 6 weeks postoperatively. CT angiogram undertaken 24 months postoperatively revealed a patent renal bypass. The patient maintained normal renal function and adequately controlled blood pressure 24 months postoperatively.

Conclusion: Open surgical correction of atherosclerotic renovascular disease can retrieve renal function in selected hypertensive patients with ischemic nephropathy. In the absence of other suitable inflow sources, the inferior mesenteric artery can be used as an alternative with acceptable outcomes.

Author(s):

Tariq Almerey, Daniel Kim, January Moore, Albert G Hakaim and Houssam Farres

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