Endovascular treatment of acute symptomatic infrarenal aortic aneurysm in a patient with bilateral atherosclerotic renal artery disease and chronic kidney disease: a case report

INTRODUCTION: Currently, X-ray endovascular technologies in the amount of endovascular aneurysm repair (EVAR) are widely used not only in the treatment of scheduled patients with abdominal aortic aneurysm, but also in emergency situations, such as acute symptomatic aneurysm or its rupture, as an alternative to an open surgery. Endovascular treatment is characterized by minimal trauma, low mortality and a short hospital stay. However, for some patients, EVAR poses significant challenges and risks. One such group is patients with chronic kidney disease due to atherosclerotic lesions of the renal arteries.

The article discusses a clinical case of a 67-year-old patient with an acute symptomatic abdominal aortic aneurysm, 5 cm in diameter, with a prominent concomitant cardiac pathology and stage IV chronic kidney disease (glomerular filtration rate 25 ml/min/1.73 m²) with the underlying critical stenosis of both renal arteries (subocclusion on the left and 85% stenosis on the right). The patient underwent emergency surgery in the amount of infrarenal aortic grafting and stenting of both renal arteries using gadodiamide. A reduction in the volume of contrast agent administered was achieved by stenting the renal arteries before EVAR. As a result, the stents, due to their radiopaque properties, were used as a guide for localizing the renal arteries during endograft placement. The postoperative period was uneventful, except for an early postoperative increase in blood creatinine up to 344 µmol/l and stabilization at this level. The patient was transferred to the vascular surgery department for symptomatic treatment. With infusion therapy, the blood creatinine level decreased to 270 µmol/l. On day 5, the patient was discharged for outpatient follow-up at the place of residence.

CONCLUSION: This clinical case demonstrates a possibility of performing endovascular intervention in patients with stage IIIb–IV chronic kidney disease, due to, on the one hand, improvement of endovascular technologies, and, on the other, reduction of the volume of contrast agent used during surgery.