Complications - Percutaneous transluminal angioplasty (PTA) and stenting in bilateral renal artery stenosis - Vascular surgery

Transfemoral probing of renal artery not possible

• Reason: angle of renal artery origin too steep, marked stenotic resistance
• Suggested solution: Change to transcubital access

“Minor” renal artery rupture

• Occlude renal artery with a dilation balloon for about 10 minutes, then check angiographically
• In case of persistent contrast agent leakage, implant a covered stent or perform end-to-end bypass (ligate the native artery at its origin from the aorta), if needed.

Renal parenchymal perforation

• Occlude segmental artery with a dilation balloon ( 3-4 mm) for 10 to 15 minutes, then check angiographically.
• In case of persistent contrast agent leakage from the parenchyma, expose the kidney by transabdominal dissection and perform hemostasis (consult with a urologist!).
• If logistics permit, attempt embolization

Renal artery occlusion

• Open repair, e.g. bypass

Thrombosis/embolism

• Dissection/plaque rupture due to puncture of highly calcified vessels
• Prevention: Detailed preoperative duplex study of access vessels

Secondary bleeding from transfemoral access

• Anticoagulants and platelet aggregation inhibitors in multimorbid patients → latent risk of (secondary) bleeding
• Open vascular suture, if needed

Acute renal artery occlusion

• Indication of acute occlusion: sudden hypertensive crisis
• Exploratory duplex study or angiography

Renal parenchymal rupture

• Exploratory spiral CT
• In severe bleeding affecting the hemodynamics, expose the kidney transabdominally (consult with a urologist!).
• Possibly embolization of the segmental artery (requirements: logistics, interventionist)