Hepatorenal Bypass for Renal Salvage: A Forgotten Option in the Endovascular Era

In this era of rapidly expanding endovascular techniques, the use of hepatorenal bypass as treatment for a critically compromised renal perfusion has largely been forgotten. This article highlights the benefits of the technique both as a bailout strategy following complications from angioplasty and as a primary treatment in cases deemed unsuitable for endovascular intervention.

Two patients are described whose renal viability was threatened by vascular compromise. One patient had a single functioning kidney with significant renal artery stenosis secondary to severe atherosclerotic disease and developed acute renal function deterioration following unsuccessful angioplasty. The second patient developed renal artery occlusion 3 years following open thoracoabdominal aortic aneurysm surgery. Both patients underwent successful hepatorenal bypass surgery and remain off dialysis 6 months after admission.

Both cases demonstrated the success of hepatorenal bypass with significant improvement in their renal function following open surgical repair.

Hepatorenal bypass, although now seldom used because of available endovascular alternatives, remains an effective method of treating complicated cases of threatened kidney secondary to vascular insult.