Peripheral Vascular Surgery Society

#14 BILATERAL EXTRA-ANATOMIC RENAL REVASCULARIZATION UTILIZING THE CELIAC ARTERY AS AN INFLOW.

Jamal J. Hoballah, MD, Richard M. Young, MD, William J. Sharp, MD,

Timothy F. Kresowik, MD, and John D. Corson, MD

The University of Iowa Hospitals and Clinics, Iowa City, IA.

A 78-year-old woman presented with poorly controlled hypertension and chronic renal insufficiency. Her past medical history was significant for diabetes, hypertension and coronary artery disease. Her past surgical history included replacement of a juxtarenal abdominal aortic aneurysm five years prior to her presentation. Laboratory values revealed a blood urea nitrogen of 55 mg/dl and a serum creatinine of 2.8 mg/dl. Angiography showed severe stenosis in the origin of the right and left renal arteries. The lateral aortogram revealed no evidence of disease in the celiac artery and the hepatic artery appeared to be of good quality. Renal revascularization was contemplated using a bilateral hepatorenal bypass. Upon exploration, the pulse in the common hepatic artery was weak and there was evidence of plaque at the origin of the common hepatic artery. The dissection was carried proximally. The celiac artery was found to be free of disease and was used as an inflow source. A celiac to right renal artery and celiac to left renal artery bypass with a reversed greater saphenous vein was performed. Her postoperative course was uneventful.

The management options for renal artery stenosis following aortic replacement will be reviewed. The celiac artery should be considered as a potential inflow source for extraanatomic renal artery revascularization when the hepatic artery is unavailable.

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Last updated January 1,2000