title: Endovascular management of renal ischemia in a patient with acute aortic dissection and renovascular hypertension.
abstract: We report the endovascular management of a patient with a type B aortic dissection complicated by renal ischemia and resultant severe hypertension. A 69-year-old male presented with acute type B aortic dissection with proximal extension complicated by severe renovascular hypertension secondary to left renal ischemia. Endovascular management consisted of imaging with intravascular ultrasound and left renal artery stenting with balloon-expandable stents. His hypertension subsequently resolved and he was discharged on his baseline two-drug regimen. Management of the ischemic complications of type B aortic dissections may be primarily approached using endovascular methods in stable patients, with open surgery reserved for those patients refractory to these methods. Patients with evidence of decreased renal perfusion represent a select group with an increased risk of associated morbidity and mortality and should therefore be aggressively managed. Accurate information and assessment of anatomy can be obtained with intravascular ultrasound and is therefore an important adjunct to the armamentarium of endovascular specialists managing complications of aortic dissection.
authors.affiliation: Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. benjamin.starnes@na.amedd.army.mil
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Starnes
authors.forename: Sean D
authors.initials: SD
authors.lastname: O'Donnell
authors.forename: David L
authors.initials: DL
authors.lastname: Gillespie
authors.forename: James M
authors.initials: JM
authors.lastname: Goff
authors.forename: Patricio
authors.initials: P
authors.lastname: Rosa
authors.forename: Norman M
authors.initials: NM
authors.lastname: Rich
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D007511:Ischemia / Q000150:complications; D007668:Kidney / Q000098:blood supply; D008297:Male; D012077:Renal Artery / Q000000981:diagnostic imaging; D015607:Stents; D018084:Ultrasonography, Interventional
chemical_list: D000959:Antihypertensive Agents