HIP: patient is 75 w/resistant hypertension and chronic renal disease who developed acut hyperkalemia and renal failure w/the initiation of an ACE inhibitor. Pt had ultrasound vascular studies of his renal arteries that demonstrated concern for bilateral artey stenosis.Despite max medical therapy on greater than 3 antihypertensives including a diuretic, he is referred for diagnostic renal angio.
PROC: R comon femoral artery was assessed using modified Seldinger technique of which a 5 French sheath was placed w/o complication. A nonselective aortography was performed of the abdominal aorta that showed intermediate stenosis of the L renal artery as well as moderate stenosis of the R renal artery. The mesenteric arteries as well as the celiac axis were imaged and there was no significant aortoiliac disease. There was no evidence of a dissection or aneurysm. Selective angioof bilateral artries was then performed w/IMA catheter. This revealed an 80% ostial stenosis of the L renal artery. There was good renal blush and all vascular territories were engaged and visualized w/single injection. The R renal artery was also selectively engaged which showed about 30% proximal disease, however no significant obstruction. Of note, on catheter engagment of the L radial artery there was significant catheter dampening.