Abstract
IntroductionAngioplasty with the use of cutting balloons has been suggested by some case reports and small series for the treatment of renal artery stenoses that are resistant to conventional balloon catheters. Based on this limited experience, the use of this technology has been suggested as safe. Herein, we report a renal artery rupture following angioplasty with a cutting balloon. The complication was salvaged with a stent graft.Case presentationA 30-year-old white female patient with resistant hypertension caused by a severe renal artery stenosis attributed to fibromuscular dysplasia, was submitted to conventional balloon angioplasty without success. Dilatation of the lesion with a cutting balloon resulted in arterial rupture, with concomitant retroperitoneal hematoma.ConclusionCutting balloon angioplasty of renal artery lesions resistant to conventional balloon angioplasty should not be considered as safe as previously thought. When proceeding with such a procedure, a stent graft should be available for immediate use.
Highlights
Introduction: Angioplasty with the use of cutting balloons has been suggested by some case reports and small series for the treatment of renal artery stenoses that are resistant to conventional balloon catheters
Three types of fibromuscular dysplasia (FMD) have been described: the medial fibroplasia which accounts for nearly 85% of the renal artery FMD lesions and is characterized by alternating webs and aneurysms; the intimal type which accounts for 5% and it is characterized by irregularly arranged mesenchymal cells within a loose matrix and fragmented elastic lamina; perimedial FMD consists approximately 10% of cases and is characterized by excessive tissue deposition at the junction of the media and adventitia [1,2]
The take-home message from our case report is that the use of cutting balloon angioplasty (CBA) for the management of resistant to conventional angioplasty renal artery FMD lesions should not be considered as safe as previously thought
Summary
Renal artery stenoses are the cause of hypertension in only 1% to 5% of the hypertensive patients. Few case reports and small series have introduced the cutting balloon angioplasty (CBA) in the management of non-atherosclerotic renal artery lesions that do not respond to conventional balloon angioplasty. A 6-F sheath was introduced in the right common femoral artery and abdominal aortography and selective renal angiography were performed with standard diagnostic catheters and depicted a focal truncal lesion which caused high-grade stenosis (Figure 1). A 6 × 10 mm cutting balloon (Cutting balloon peripheral, Interventional Technologies Europe, Ltd, Ireland) was placed across the lesion and dilated at 6 atmospheres but the waist could not be effaced; it was dilated at 8 atmospheres resulting into waist elimination At this time point, the patient complaint of severe abdominal pain and she developed hypotension (60/40 mmHg). While the Doppler ultrasonography of the right renal artery is normal one year after the intervention
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