Transbrachial renal artery angioplasty and stenting in patients with Leriche's syndrome

Background. In the process of therapeutic management of patients with Leriche's syndrome and renal artery stenosis we face the dilemma of which surgical technique and sequence of reconstructive procedures to choose. The aim of the study was the assessment of grounds for preliminary renal artery angioplasty prior to implantation of aorto- bifemoral prostheses in patients with Leriche's syndrome and concomitant renovascular hypertension. Material and methods. In the years 2001- 2005 twelve patients were treated for renovascular hypertension and aortic and bilateral femoral artery occlusion. The diagnosis was verified with Doppler sonography, digital subtraction angiography (DSA) and captopril renal scintigraphy (CRS). Digital subtraction angiography and endovascular procedures were performed through left brachial or axillary artery access under local anaesthesia. In 9 patients the procedure of implantation of bifurcated aorto- bifemoral prosthesis was performed within 5- 8 days following renal revascularisation. In two other patients, following endovascular dilatation and stenting of the renal artery, the reconstruction of the aortofemoral segment was postponed, and the patients were discharged. In one patient the bifurcated prosthesis was implanted on an emergency basis 14 days before renal angioplasty due to acute limb ischaemia secondary to acute arterial thrombosis. The patients were reevaluated after 30 days, and at 3, 6 and 12- month follow- ups. Results. In all 12 patients, renal artery angioplasty followed by stent implantation (Palmaz Genesis, Cordis - 7 patients; Nefro, Balton - 5 patients) was successful. Mean PRA value before the procedure was 13.7 ng/ml/h. After angioplasty, renographic parameters improved and mean PRA value decreased to 7.2 ng/ml/h. All of the patients presented some improvement in their clinical status together with blood pressure normalization. Conclusions. 1. Patients with symptomatic aortoiliac occlusion and arterial hypertension require assessment of their renal arteries and, in the case of stenosis, their assessment should be extended with renal function tests. 2. Haemodynamically significant renal artery stenosis provides an indication for endovascular dilatation, through the access from upper limb arteries, before the bifurcated aorto- bifemoral prosthesis is implanted.