Splenorenal bypass in suprarenal aneurysm with solitary left kidney: a case report
Derivação esplenorrenal para tratamento de aneurisma suprarrenal com rim esquerdo solitário: relato de caso
Utkarsh Anand; Gokulakrishnan Hari; Vishesh Gupta; Varsha Khandelwal; Tanuj Singla; Ujjwal Gorsi; Ajay Savlania
Abstract
Keywords
Resumo
A revascularização renal em pacientes com rim solitário funcional e aneurisma de aorta abdominal (AAA) suprarrenal representa um desafio cirúrgico devido ao risco de isquemia e disfunção renal pós-operatória. Apresentamos o caso singular de um homem de 69 anos com rim esquerdo único e AAA suprarrenal, tratado com sucesso com anastomose preemptiva entre a artéria renal esquerda e a artéria esplênica (derivação esplenorrenal), seguida de aneurismorrafia. Essa abordagem preservou a função renal e evitou insulto isquêmico durante a reconstrução aórtica. Após 2 anos de acompanhamento, o paciente mantém parâmetros renais estáveis e reconstrução pérvia, reforçando a utilidade da derivação esplenorrenal como alternativa viável em cenários anatomicamente restritos e de alto risco.
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Referências
1 Song P, He Y, Adeloye D, et al., The global and regional prevalence of abdominal aortic aneurysms: a systematic review and modeling analysis. Ann Surg. 2023;277(6):912-9.
2 Lim J, Truong HD, Song TY, Giam WJ, Koh EL, Tan JK. The interdependent hemodynamic influence between abdominal aortic aneurysm and renal artery stenosis. Sci Rep. 2024;14(1):31986.
3 Studzińska D, Rudel B, Polok K, et al. Infrarenal versus suprarenal abdominal aortic aneurysms: comparison of associated aneurysms and renal artery stenosis. Ann Vasc Surg. 2019;58:248-54.e1.
4 Sathi S, Garg AK, Saini VS, Singh MK, Ali A, Vohra D. Fate of the solitary kidney-nephrologist panorama. Nephrourol Mon. 2025;17(2):e156924.
5 Yamamoto Y, Uchiyama H, Oonuki M. Effects of suprarenal aortic cross-clamping and adjunctive renal reconstruction on outcomes of open abdominal aortic aneurysm repair. Ann Thorac Cardiovasc Surg. 2022;28(4):278-85.
6 Hahl T, Kurumaa T, Uurto I, Protto S, Väärämäki S, Suominen V. The effect of suprarenal graft fixation during endovascular aneurysm repair on short-and long-term renal function. J Vasc Surg. 2022;76(1):96-103.e1.
7 Thompson JE, Smithwick RH. Human hypertension due to unilateral renal disease, with special reference to renal artery lesions. Angiology. 1952;3(6):493-505.
8 Wylie EJ. Vascular replacement with arterial autografts. Surgery. 1965;57(1):14-21. PMid:14242042.
9 Stoney RJ, De Luccia N, Ehrenfeld WK, Wylie EJ. Aortorenal arterial autografts: long-term assessment. Arch Surg. 1981;116(11):1416-22.
10 Textor SC, McKusick MM, Misra S, Glockner J. Timing and selection for renal revascularization in an era of negative trials: what to do? Prog Cardiovasc Dis. 2009;52(3):220-8.
11 Bhalla V, Textor SC, Beckman JA, et al., Revascularization for renovascular disease: a scientific statement from the American Heart Association. Hypertension. 2022;79(8):e128-43. PMid:35708012.
12 Vallabhaneni SR, Patel SR, Campbell B, et al. Editor’s choice – Comparison of open surgery and endovascular techniques for juxtarenal and complex neck aortic aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) – peri-operative and midterm outcomes. Eur J Vasc Endovasc Surg. 2024;67(4):540-53.
13 Dong S, An C, Caputo FJ, et al. Renal artery reimplantation versus bypass in elective open aneurysm repair. Ann Vasc Surg. 2024;98:102-7.
14 Jessula S, Herman CR, Lee M, Lightfoot CB, Casey P. Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass. J Vasc Surg Cases Innov Tech. 2017;3(3):163-6.
15 Khauli RB, Novick AC, Ziegelbaum M. Splenorenal bypass in the treatment of renal artery stenosis: experience with sixty-nine cases. J Vasc Surg. 1985;2(4):547-51.
Submetido em:
26/05/2025
Aceito em:
20/08/2025
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