Trapped renal arteries: Functional renal artery stenosis due to occlusion of the aorta in the arch and below the kidneys

Acute renal failure is a well recognized complication from the use of angio tensin-converting enzyme inhibitors in patients with severe bilateral renov ascular disease. A 54-year-old woman presented with acute pulmonary edema w ith intractable hypertension and a history of lower limb claudication. The addition of lisinopril to her antihypertensive regimen resulted, within 48 h, in the development of acute renal failure that remitted with cessation o f the drug. She was found to have a heavily calcified occlusion of her aort ic arch and another occlusion of the aorta below the renal arteries. Angiog raphy and Doppler ultrasonography showed normal renal arteries. This is the first reported case of angiotensin-converting enzyme inhibitor-induced ren al failure occurring in a patient with atherosclerotic occlusion of the aor ta. The literature on suprarenal aortic occlusion is reviewed to determine the manner of presentation, prevalent risk factors and physical findings th at typify this unique clinical entity.