[Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft].
The thrombotic occlusion of one renal artery may become completely asymptomatic, due to the functionality of the contralateral kidney. However, in rare circumstances, such is the case of individuals with a solitary kidney, a situation of anuria and acute renal failure may constitute the main presentation of the condition. The authors report the clinical case of a 43 year old male patient, with the previous diagnosis of an infrarenal aortic occlusion and a single left kidney, who developed a thrombotic occlusion of the renal artery, with anuria and acute renal failure. The patient underwent an emergency revascularization procedure, consisting in the implantation of a prosthetic bypass graft from the superceliac aorta to the renal artery, with immediate recovery of the diuresis and renal function. Seventeen months later as a consequence of an anastomotic hyperplasia, an occlusion of the bypass graft occurred, again with anuria and acute renal failure. The patient was reoperated on and due to the inadequacy of both saphenous veins to be used as the material of choice for the revascularization procedure, a redundant segment of the left colic artery (Riolan's arcade) was removed and used as an interposition graft, from the middle colic artery to the renal artery, followed by an immediate restoration of diuresis and renal function. The singular and recurrent character of this clinical condition and the utilization of an original, eventually unique and well succeeded revascularization procedure, prompted its presentation and divulgation.
da Gama
A Dinis
AD
Clinica Universitária de Cirurgia Vascular do Hospital de Santa Maria, Lisboa.
Nunes
J Silva
JS
Cunha e Sá
Diogo
D
Pedro
Luís Mendes
LM
D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D001002:Anuria / Q000150:complications; D001158:Arteries / Q000637:transplantation; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000098:blood supply*; D008297:Male; D012008:Recurrence; D012077:Renal Artery / Q000601:surgery*; D013927:Thrombosis / Q000150:complications / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods