Bilateral ureteral obstruction following aortic bypass surgery

Area of Science:

• Nephrology
• Vascular Surgery
• Radiology

Background:

• Aortofemoral bypass grafts are used to treat atherosclerosis.
• Retroperitoneal fibrosis is a potential complication following abdominal vascular prosthesis placement.
• Patients may be asymptomatic until advanced azotemia occurs.

Observation:

• A patient presented with azotemia due to bilateral ureteral obstruction caused by retroperitoneal fibrosis after aortofemoral bypass surgery.
• This complication may be underrecognized due to asymptomatic progression.
• Silent kidney damage can be misattributed to other conditions like vascular or prostatic disease.

Findings:

• Retroperitoneal fibrosis can lead to ureteral obstruction and subsequent azotemia.
• Gradually increasing azotemia in patients with a history of aortofemoral bypass warrants consideration of ureteral obstruction.
• Imaging modalities like CT, isotope renography, and sonography are vital for early diagnosis.

Implications:

• Retroperitoneal fibrosis should be included in the differential diagnosis for azotemia post-aortofemoral bypass.
• Postoperative surveillance with imaging may aid in early detection and intervention.
• Prompt diagnosis and management can prevent irreversible kidney damage.