Hypertensive crisis managed by bilateral renal artery reconstruction

In hypertensive emergencies the physician is obligated to reduce arterial pressure immediately. This is best done with intravenous antihypertensive agents. If renal artery occlusion is demonstrated and the patient is refractory to appropriate medications, renal artery reconstruction may be necessary. In the poor risk patient, an attempt at transcatheter thromboembolectomy may be worthwhile. If this maneuver is unsuccessful, emergent aorto-renal reconstruction is indicated. A case of bilateral renal artery thromboses causing a hypertensive crisis which was successfully managed by aorto-renal bypass grafting is reported.