A 72-year-old patient was admitted for elective surgery for infrarenal abdominal aortic aneurysm and right hypogastric artery.
As personal history highlights right nephrectomy in 1983 for renal cell carcinoma, hypertension controlled with old bulge and inferolateral AMI silent.
The DIVAS showed diffuse aortic ectasia and fusiform aneurysmal dilatation with a neck located 17 mm from the left renal artery, with mural thrombus of 7 mm inside and a maximum lumen caliber of 35 mm.
Aneurysmal dilatation affects both iliac arteries and a second fusiform aneurysm of 13 mm was observed in the right hypogastric artery.
Permeability of celiac axis, left renal artery, superior mesenteric artery and occlusion of inferior mesenteric artery were confirmed.
The patient underwent surgery with aortic endoprosthesis (Quantum Cordis®) 36-12 extending to both iliac arteries and embolization of the right hypogastric artery.
The control renal arteriography was normal.
Two hours after surgery, anuria of sudden onset was observed, with no improvement with diuretic infusion.
Urgent arteriography (6 h postoperative) showed total occlusion of the ostium of the left renal artery by skull migration of the stent.
The decision was made to perform an emergency revascularization surgery using an adrenal shunt due to left lateral lumbotomy at the XIIth rib.
Left renal dissection was performed (1 artery, 1 vein) with renal reperfusion using ringer lactate at 4 C and end-to-end anastomosis with splenic artery (puntone® tapes/0).
Reperfusion of the kidney was performed 12 h after the onset of anuria, progressively showing color and consistency, maintaining anastomosis a good pulse.
Spontaneous diuresis reappeared 48 h later, previously requiring a hemodialysis session due to hyperkalemia and acidosis.
Control Magnetic Resonance Angiography (2 months) demonstrated endoprosthesis patency, endoleaks ausen-cy of endoleaks in the well-controlled anastomosis and creatinine continues with 1.4 mg / dl.
