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Submitted: 12 Apr 2019
Accepted: 02 Jul 2019
ePublished: 27 Jul 2019
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J Renal Inj Prev. 2019;8(4): 253-256.
doi: 10.15171/jrip.2019.48

Scopus ID: 85076295549
  Abstract View: 2065
  PDF Download: 1455

Case Report

Spleno-renal anastomotic bypass revascularization for worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic renal artery stenosis

Macaulay Amechi Chukwukadibia Onuigbo 1* ORCID logo, Marie Engesser 1, Sree Susarla 1

1 Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT. UHC Campus, 1 South Prospect Street, Burlington, VT 05401, USA
*Corresponding Author: *Corresponding author: Macaulay Amechi Chukwukadibia Onuigbo, Email: , Email: macaulay.onuigbo@uvmhealth.org

Abstract

Following the recent publications of the STAR-study, the ASTRAL trial, the HERCULES trial and the CORAL trial on renal revascularization versus medical therapy in the management of atherosclerotic renovascular disease, there has been a near paradigm shift implying the nonutility of revascularization as a useful and necessary therapeutic option. Our recent experience with a patient who underwent an anastomotic bypass revascularization for worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic renal artery stenosis in Burlington, VT rekindled this debate. We posit that in appropriately selected patients, patients with acutely worsening renal failure, uncontrolled hypertension and/or symptomatic pulmonary edema, there is indeed a place for revascularization therapy, especially in the light of improved and safer surgical and anesthesiology techniques. It must be correctly acknowledged that the above well popularized randomized trials recruited mostly patients with otherwise stable chronic kidney disease at the time of enrollment. Similarly, only 12% of the patients in both arms of the ASTRAL trial demonstrated rapidly worsening renal failure prior to enrollment

Implication for health policy/practice/research/medical education:

There continues an ongoing debate as to the appropriateness and/or utility of mechanical revascularization procedures in the management of atherosclerotic renovascular disease. In the light of more recent trails including the STAR-study, the ASTRAL trial, the HERCULES trial and the CORAL trial, the general consensus has gravitated towards the opinion that there is hardly any indication for such revascularization procedures versus medical therapy alone. Our recent experience with a female patient with symptomatic and progressive atherosclerotic renovascular disease who responded promptly to spleno-renal anastomosis has rekindled this controversy. We posit that in appropriately selected patients with a priori worsening renal failure, uncontrolled or accelerated hypertension and/or pulmonary edema, there is indeed a place for the mechanical therapeutic restoration of renal blood flow.

Please cite this paper as: Onuigbo MAC, Engesser M, Susarla S. Spleno-renal anastomotic bypass revascularization for worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic renal artery stenosis. J Renal Inj Prev. 2019;8(4):253-256. DOI: 10.15171/jrip.2019.48.

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