Obstruction of para-renal aorta, associated to mesenteric and renal occlusion, of unknown etiology. Surgical management

The clinical case of a 44-year old female is reported, whose chief complaints were arterial hypertension and disabling intermittent claudication of both legs. Angiography disclosed a segmental occlusion of the para-renal aorta, associated to an occlusion of superior mesenteric and left renal arteries and a critical stenosis of the right renal artery, probably of degenerative etiology ("coral reef"), but not comproved by pathological studies. The patient underwent a complex revascularization procedure, consisting in the implantation of a bypass graft from the supraceliac aorta to both common femoral arteries through a retropancreatic way, followed by superior mesenteric and both renal arteries revascularization by means of independent PTFE grafts attached to the main bypass graft. Post-operative course was uneventful and blood pressure returned to normal values. An angio-CT control study revealed the integrity of the revascularization procedure and the recovery of the left kidney functionality, whose artery was completely occluded. Te etiology, topography and surgical management of this most demanding situation are subjected to an analysis and discussion.