Narrowing at the origin of the renal artery from an aortic graft can pose a deceptive clinical situation. In some cases, the vessel may not be entirely occluded, and diagnostic imaging might show the renal artery as being adequately outlined. This can lead to a false assumption during intraoperative angiography that the kidney receives sufficient blood supply.
However, despite the seemingly normal imaging results, the pressure within the glomerular capillaries might not be high enough to allow for proper filtration and urine production. If recognized early, restoring adequate blood flow to the kidney presents a promising opportunity for recovery. Once normal renal artery flow is reestablished, the kidney has a high chance of resuming urine production.
There isn’t a strict time frame within which this needs to happen. As long as the kidney remains perfused, there is still time to attempt further interventions to improve flow. Techniques such as stent angioplasty or even a bypass procedure may be employed to optimize the blood supply and help restore the kidney’s ability to produce urine. Timely intervention is essential, but the kidney often has a remarkable capacity to recover function if adequate perfusion is maintained or improved. This flexibility allows clinicians to decide the best approach to increase the possibility of renal recovery.
In the image above, the right renal artery, although patent, is half occluded by the aortic stent graft. The arrow depicts the top marker of the main body endograft, indicating its most proximal extension.