Proximal Extension of Juxtarenal Aortic Thrombosis: An Underestimated Complication?

Aorto-iliac occlusive disease sometimes extends proximally with involvement of the renal arteries and visceral aorta, with loss of renal functional mass and intestinal ischemia. In this article we report the case of a patient presenting with progressive disabling intermittent claudication caused by chronic juxtarenal aortic thrombosis with proximal progression and involvement of the left renal artery, with a functional kidney preserved by the collateral circulation. This imagiologic finding led to a change in the usual surgical procedure, needing a supraceliac aortic clamp. Simultaneously, we choose to revascularize the left renal artery while perfunding the right renal artery with cold Ringer’s lactate solution during clamping period. No complications occurred during the surgery and post-operative period. Renal involvement in aortic juxtarenal thrombosis occurs in 3 to 15% of the cases but demands a more complex surgical approach with more proximal aortic clamping level as well as the use of intraoperative strategies to protect the visceral and renal territories.