The use of renal stents in atherosclerotic renal artery stenosis has been mired in controversy secondary to poorly designed randomized clinical trials which demonstrated minimal benefit over medical management. This publication illustrates the deployment of an isolated renal stent as an ancillary procedure for a patient with a 5.5cm juxtarenal AAA in need of fenestrated endovascular repair.
Under general anesthesia, the patient was prepped with the left arm tucked. Access via the right common femoral artery over the femoral head was obtained under ultrasound guidance. Using the Seldinger technique, a long sheath (Ansell) was inserted to the level of the infrarenal aorta. A Glidewire (Terumo) was used to enter the right renal ostia with the assistance of an Omniflush (Angiodynamics) catheter after an initial aortogram. A Rosen (Cook) wire was exchanged and the sheath was advanced past the stenosis over the dilator. The balloon mounted iCAST (Atrium) stent was positioned and the sheath pulled back. The stent was deployed and flared using a Flash ostial balloon (Cordis). Completion angiography demonstrated excellent flow through the right renal artery and into the terminal renal branches.
The patient recovered uneventfully overnight with a stable Cr the next morning. Four weeks after his renal intervention, the patient was taken to the operating theatre for a successful 3-vessel fenestrated aortic repair. At the most recent 6-month follow-up, the patient had a stable Cr and residual aortic sac diameter.
While the use of renal stenting in hypertension related to atherosclerotic renal artery disease continues to remain controversial, this intervention can still be performed as an adjunctive procedure in select cases with excellent technical success and low morbidity.
Raghu L. Motaganahalli