[Extracorporeal arterial reconstructive surgery in complex vasculo-renal pathology]

Herein we describe a case of a 23-year-old male patient with severe hypertension that was refractory to medication, a hypoplastic left kidney and complex renovascular disease. Patient evaluation revealed stenosis of the right renal artery and saccular aneurysms of its three branches. Treatment with converting enzymes was discarded due to the risk of azotemia and the complex vascular disease advised against percutaneous transluminal angioplasty. He was therefore submitted to ex situ vascular repair (bench surgery) using the hypogastric artery with its three branches and autotransplantation in the right iliac fossa. The foregoing procedure achieved excellent results. The arterial pressure and overall renal function returned to normal 15 days postoperatively. In our view extracorporeal surgery is the procedure of choice in patients with complex renovascular disease involving the small branches of the renal artery.