Late stenosis of an aortorenal bypass graft fashioned from pericardium

Renal artery stenosis (RAS), especially secondary to fibromuscular dysplasia, is a curable cause of hypertension in children. Although aortorenal bypass was the preferred treatment for this disease twenty years ago, newer techniques are available. We report a 27-year-old patient who, at 7 years of age, had severe hypertension secondary to RAS in a solitary kidney. Aortorenal bypass with an autologous pericardial graft resulted in normal blood pressure for 20 years until the pericardial graft thrombosed. Normal blood pressure has again been achieved following resection of the stenotic renal artery with reanastomosis to the aorta.