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Nan Jia, Xiaobo Li, Bo Tao, Xiaofeng Tang Shaoli Chu, Pingjin Gao Department of Hypertension Ruijin Hospital Shanghai Jiao Tong University School of Medicine Experiences and lessons in the Intervention of renal artery stenosis associated with serious abdominal aortic distorted
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74 year-old female Height: 154 cm; Weight: 52 kg High blood pressure for 30 years In the last two months, blood pressure severely elevated to 180-200/80-90 mmHg with 4 anti-hypertension drugs: amlodipine+Hyzaar+lacidipine+bisoprolol Present History
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On Sep 21, 2012, this patient came to our hospital. Admission blood pressure: 187/78 mmHg Heart Rate: 77 beats/min Foamy urine, nocturia 3-4 times/night, no hematuria Present History
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Three years ago, she felt dizzy and CT results showed cerebral infarction History of hyperlipidemia several years statins treatment History of chronic renal disease for two years Past History
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Renal function : Scr: 134-169 (53.0-115.0 μmol/L) UA :274 (160-430 mmol/L) total urinary protein: 204 mg/1500ml urine (24-150 mg/24h) Urinary albumin creatinine ratio: 10.49 (male<2.5,female<3.5) Blood-fat: TG : 1.24 (0.56-1.70 mmol/L) TC: 6.83 (2. 33-5. 70 mmol/L); HDL:1.38 (0.80-1.80 mmol/L) ; LDL: 5.24 (1.30-4.30 mmol /L) Blood Biochemistry
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Abdomen ultrasound: double kidney reflection is fuzzy Right kidney: 93 x 30 mm ; left kidney: 103 x 42 mm ; nephro-dynamic imaging: Bilateral GFR severely reduced Right: 17.48 ml/min; Left: 19.37 ml/min; Imaging Findings
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Abdominal MRA
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Equipment: 7FRDC guiding catheter Ryujin 0.035 “black loach” guide wires 0.014 Runthrough guide wires Invatec 3.0X20 mm balloon Hippocampus 5.0X20 mm stent*2 4FMPA-1 multifunctional catheter 6F Angioseal Renal Arteriography
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Serious abdominal aortic distorted Bilateral renal artery stenosis Right: 80% located in posterolateral of abdominal aorta Left: 90%, post-stenotic dilatation, distal artery distorted Angiographic results
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1.Right renal artery ostial visualizing unclear 2.“Black Loach ” and Runthrough guide wire hard to go through the distorted segment of left renal artery 3.Right renal artery ostial located in posterolateral of abdominal aorta and Runthrough guide wire failed to enter even with the support of double “Black Loach” guide wire. 4. “the co-axle technique” was adopted with 4FMPA-1 catheter and Runthrough “floated” into the right renal artery then stent placement was successfully implemented During intervention
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left renal artery angiography
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Left renal artery stent placement
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Right renal artery angiography
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Right renal artery stent placement
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1.Bilateral renal artery stenosis associated with serious abdominal aortic distorted 2.Ostial stenosis associated with calcification\ atherosclerotic plaques 3.Good support guarantee the guide wire through the lesion 4.Use “the co-axle technique” will provide a good support force 5.Even sufficient predilation was conducted, stent motion still occurring in some extent 6.“spit out phenomenon” should be predict and stent positioning should be operated with caution Experiences and lessons
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