A Case of Descending Aorta-abdominal Aorta Bypass with Reconstruction of Bilateral Renal Artery for a Patient with Atypical Coarctation

Abstract

A 58-year-old man, who had undergone axillo-bifemoral bypass at another hospital 10 years previously for atypical coarctation, has repeated hospitalization for hypertensive cardiac insufficiency since last year. He was referred to our university hospital for surgical revascularization of the renal arteries (RAs) to improve the prognosis of cardiac insufficiency. In surgery, descending aorta-abdominal aorta bypass with revascularization of bilateral RAs was performed via left thoracotomy and retroperitoneal approach. He had an uncomplicated postoperative course. The serum renin activity, which was 10.6 ng/mL/h before surgery, markedly decreased to 1.1 ng/mL/h after surgery and the left ventricular ejection fraction was improved from 28% to 40% a month after surgery. In patients with atypical coarctation and visceral malperfusion, hypertensive heart failure may worsen after axillo-bifemoral bypass, and revascularization of the RAs was effective to improve heart failure.