Percutaneous recanalization of occluded renal arteries.

Acute embolic renal artery occlusion is usually clinically typical. In case of early diagnosis, an in situ thrombolysis may be effective. As thrombosis often progressively completes a severe renal artery stenosis, the classical clinical description of renal infarction (lombar pain, hemat uria) is frequently not present. The kidney parenchyma downstream from the renal arterial occlusion is not a lways irreparably lost: collateral circulation may preserve nephron viabili ty, which requires a lower perfusion pressure than glomerular filtration. A n iodine, isotopic, or MR gadolinium nephrogram may prove this viability. Over the last 10 years, we attempted 21 percutaneous recanalizations of ren al artery occlusion. Mean patient age was 62 years (44-85). All were hypert ensive. Serum creatinin level of 17 patients was above 130 micromoles/ml. T hree patients were previously hemodialysed. We observed 8 failures, without any complication. Thirteen immediate techni cal successes occurred, but one rethrombosis occurred at Day 1. Immediate c omplications were seen in 2 patients: 1 acute pulmonary edema, 1 puncture s ite false aneurysm. The mean follow up of the 12 technical successes was 26 months (18-60). One rethrombosis occurred at 6 months. Hypertension was unchanged in 4 patient s and improved in 8. In all patients with renal insufficiency, a significat ive improvement of serum creatinine level was observed. It was possible to discontinue hemodialysis in the 3 patients previously hemodialysed. One predictive factor of success was recognized: a short delay (shorter tha n 90 days) between occlusion and recanalization. Percutaneous recanalization must be proposed in case of renal artery occlus ion, especially to avoid vascular azotemia and dialysis, even if the kidney fed by the occluded artery is small.