Isolated Spontaneous Renal Artery Dissection: A Case Report and Review

Abstract

We report an interesting case of a 65-year-old gentleman who presented with hypertensive emergency and was found to have an isolated spontaneous dissection of the right renal artery. The dissection was stented via endovascular approach and resulted in marked improvement in blood pressure. Spontaneous renal artery dissection is a difficult condition to diagnose and treat, unless suspected early enough during the course of treatment. Endovascular intervention is the treatment of choice, as failure of conservative treatment may have long lasting clinical implications relating to decreased renal perfusion. Surgical intervention can be associated with high rate of complications.

Keywords

renal artery obstruction - renovascular hypertension

• References

• 1 Béroniade V, Roy P, Froment D, Pison C. Primary renal artery dissection. Presentation of two cases and brief review of the literature. Am J Nephrol 1987; 7 (5) 382-389
• 2 Hirst Jr AE, Johns Jr VJ, Kime Jr SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37 (3) 217-279
• 3 Lacombe M. Isolated spontaneous dissection of the renal artery. J Vasc Surg 2001; 33 (2) 385-391
• 4 Edwards BS, Stanson AW, Holley KE, Sheps SG. Isolated renal artery dissection, presentation, evaluation, management, and pathology. Mayo Clin Proc 1982; 57 (9) 564-571
• 5 Ramamoorthy SL, Vasquez JC, Taft PM, McGinn RF, Hye RJ. Non operative management of acute spontaneous renal artery dissection. Vasc Surg 2002; 157: 162
• 6 Harrison Jr EG, Hunt JC, Bernatz PE. Morphology of fibromuscular dysplasia of the renal artery in renovascular hypertension. Am J Med 1967; 43 (1) 97-112
• 7 Thomas MC, Walker RJ, Packer S. Running repairs: renal artery dissection following extreme exertion. Nephrol Dial Transplant 1999; 14 (5) 1258-1259
• 8 Iqbal FM, Goparaju M, Yemme S, Lewis BE. Renal artery dissection following marathon running. Angiology 2009; 60 (1) 122-126
• 9 Acconcia A, Manganelli A. Dissecting aneurysm of renal artery owing to subadventitial angioma. J Urol 1978; 119 (2) 268-270
• 10 Kanofsky JA, Lepor H. Spontaneous renal artery dissection. Rev Urol 2007; 9 (3) 156-160
• 11 Misrai V, Peyromaure M, Poiree S, Marteau V, Laurian C. Spontaneous dissection of branch renal artery- is conservative management safe and effective?. J Urol 2006; 176 (5) 2125-2129
• 12 Müller BT, Reiher L, Pfeiffer T , et al. Surgical treatment of renal artery dissection in 25 patients: indications and results. J Vasc Surg 2003; 37 (4) 761-768
• 13 van Rooden CJ, van Baalen JM, van Bockel JH. Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation1. J Vasc Surg 2003; 38 (1) 116-122
• 14 Pellerin O, Garçon P, Beyssen B , et al. Spontaneous renal artery dissection: long-term outcomes after endovascular stent placement. J Vasc Interv Radiol 2009; 20 (8) 1024-1030
• 15 Mudrick D, Arepally A, Geschwind JF, Ronsivalle JA, Lund GB, Scheel P. Spontaneous renal artery dissection: treatment with coil embolization. J Vasc Interv Radiol 2003; 14 (4) 497-500