Renal Artery Stenosis Due To Entrapment

Abstract

INTRODUCTION Entrapment of the celiac artery by the median arcuate ligament and diaphragmatic crura is a known clinical entity. There have been rare reports of extrinsic compression of the renal arteries by the diaphragmatic crura leading to secondary renal pathology. METHODS RESULTS Both operations were uncomplicated. At 1month follow-up, renal doppler of both patients demonstrated resolution of dynamic compression of the renal artery. PSV and accelerations indices were all within normal limits. In both patients, improvement in blood pressure control was noted. Discontinuation of anticoagulation was possible in the patient who had recurrent embolic episodes. CONCLUSION Extrinsic compression of renal artery by diaphragmatic crura is rare, but a definite anatomic and clinical entity. Work-up should include dynamic imaging to assess for compression of renal arteries during expiration. Surgical decompression of renal arteries is a viable option. Renal artery entrapment should be included in the differential diagnosis in younger patients with hypertension without demonstrable intrinsic disease, especially when anomalous origin of the renal artery or proximity to the diaphragmatic crura are seen on cross sectional imaging. Entrapment of the celiac artery by the median arcuate ligament and diaphragmatic crura is a known clinical entity. There have been rare reports of extrinsic compression of the renal arteries by the diaphragmatic crura leading to secondary renal pathology. Both operations were uncomplicated. At 1month follow-up, renal doppler of both patients demonstrated resolution of dynamic compression of the renal artery. PSV and accelerations indices were all within normal limits. In both patients, improvement in blood pressure control was noted. Discontinuation of anticoagulation was possible in the patient who had recurrent embolic episodes. Extrinsic compression of renal artery by diaphragmatic crura is rare, but a definite anatomic and clinical entity. Work-up should include dynamic imaging to assess for compression of renal arteries during expiration. Surgical decompression of renal arteries is a viable option. Renal artery entrapment should be included in the differential diagnosis in younger patients with hypertension without demonstrable intrinsic disease, especially when anomalous origin of the renal artery or proximity to the diaphragmatic crura are seen on cross sectional imaging.