Acute renal artery stent thrombosis with a solitary functioning kidney

A 55-year-old woman with a history of hypertension, bilateral renal artery disease with a left renal artery stent, and a chronically occluded right renal bypass graft presented with anuria and acute renal failure. Diagnostic studies showed high-grade renal artery in-stent stenosis with thrombotic occlusion of the main left renal artery distal to the stent. Catheter-directed thrombolysis and stent-in-stent placement within the left renal artery were successful at restoration of renal artery perfusion and function. Acute renal artery thromboembolic events are rare but can be devastating when these occur bilaterally or within a solitary functioning kidney. Timely diagnosis and therapy can often restore renal function and prevent dialysis dependence. The evolution of therapy for acute renal thromboembolism is discussed in this study. Recurrent stenosis within a stented renal artery is not uncommon and can be dependent on certain risk factors. Routine surveillance duplex ultrasound after endovascular therapy is essential for prevention of restenosis or thrombotic stent occlusion. The optimal therapy for in-stent restenosis is not defined; however, restenosis rates are lower with repeat stent-in-stent procedures as opposed to balloon angioplasty alone.