Inferior Mesenteric Artery as an Inflow for Unilateral Renal Artery Revascularization

Methods: A 73-year-old female presented with rapidly deteriorating renal function and uncontrolled hypertension secondary to ischemic nephropathy due to chronic renovascular occlusive disease. The patient had failed prior Percutaneous Transluminal Angioplasty (PTA) attempts. Preoperative evaluation showed the right kidney to be atrophied and normal size left kidney. Intraoperative exploration revealed porcelain abdominal aorta and both common and external iliac arteries were heavily calcified and were not suitable for appropriate clamping or to be used as an inflow for renal revascularization. Although the patient was asymptomatic, both celiac artery and Superior Mesenteric Artery (SMA) were nearly occluded and severely stenosed, respectively, at their origins. Therefore, the splenic artery and SMA were not used for reconstruction. Further exploration revealed a minimally diseased and widely patent Inferior Mesenteric Artery (IMA). A unilateral renal revascularization was performed via an IMA to left renal artery bypass using PTFE graft via a midline laparotomy.