Acute bilateral renal artery occlusion. Revascularization with the splenic artery

Although acute renal artery occlusion usually leads to kidney necrosis, preexisting collateral vessels may occasionally preserve the organ long enough to permit revascularization. This principle was demonstrated in a patient in whom bilateral acute renal artery occlusion developed following repair of an aortoduodenal fistula. Approach to the aorta for primary revascularization was interdicted by extensive scarring. Accordingly, bilateral renal artery revascularization was successfully effected with the use of the splenic artery and reversed saphenous vein grafts through extra-anatomic planes. This experience demonstrates the importance of an aggressive diagnostic and therapeutic approach to acute renal artery occlusion, as well as the usefulness of the large-caliber, lengthy, disease-free, dispensable splenic artery as a revascularization source.