Case Vignettes.

Area of Science:

• Interventional Radiology
• Cardiology
• Vascular Surgery

Background:

• A 72-year-old male with severe bilateral renal artery disease and compromised cardiac health was admitted for elective non-operative correction of left renal artery stenosis.
• The patient had a history of coronary artery disease, multiple cardiac care unit admissions, and acute pulmonary edema despite prior interventions.

Purpose of the Study:

• To describe a challenging case of iatrogenic left renal artery occlusion during an attempted percutaneous intervention.
• To highlight the complications encountered and the subsequent management dilemma.

Main Methods:

• Percutaneous access to the left renal artery was attempted by an interventional radiologist.
• A guide wire tip fractured and occluded the vessel, rendering retrieval attempts by interventional cardiology unsuccessful.
• A brachial artery hematoma complicated the vascular access site.

Main Results:

• The attempted intervention for left renal artery stenosis resulted in complete occlusion of the vessel due to a retained guide wire fragment.
• Standard retrieval techniques failed, and the access site developed a hematoma.
• Vascular surgery deemed open revascularization not feasible.

Conclusions:

• This case illustrates a rare but significant complication during renal artery intervention.
• Management of iatrogenic arterial occlusion requires careful consideration of alternative strategies when standard methods fail and surgical options are limited.