|Year : 2019 | Volume
| Issue : 3 | Page : 56-57
Renovascular hypertension after laparoscopic adrenalectomy in a young patient
Chunmin Li, Hualiang Ren, Chuanjun Liao, Wangde Zhang
Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
|Date of Submission||06-Sep-2019|
|Date of Decision||09-Jul-2020|
|Date of Acceptance||10-Jul-2020|
|Date of Web Publication||25-Aug-2020|
Dr. Wangde Zhang
Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
Source of Support: None, Conflict of Interest: None
As 23-Year-old patient suffered from intermittent headache, dizziness and palpitation especially after physical activity for 1 month. A remarked rise of blood pressure as high as 200/100mmHg was found. The CTA revealed a severe stenosis of right renal artery. 5 months ago, he underwent a laparoscopic adrenalectomy. The TVH was totally relived by renal arterial angioplasty.
Keywords: Angioplasty, adrenalectomy, renovascular hypertension
|How to cite this article:|
Li C, Ren H, Liao C, Zhang W. Renovascular hypertension after laparoscopic adrenalectomy in a young patient. Transl Surg 2019;4:56-7
Renovascular hypertension (RVH) is a kind of secondary rise of blood pressure to the unilateral or bilateral stenosis of renal artery(s). The most common causes of the renal artery stenosis (RAS) are atherosclerotic disease and fibromuscular dysplasia. Traumatic RAS is a relatively rare condition which accounts for 0.57% in patients referred for hypertension. Few cases of iatrogenic RVH have been reported in the literature. Here, we presented an unusual case of RAS resulted by surgical procedure whose hypertension was cured by angioplasty satisfactorily.
A 23-year-old man suffered from intermittent headache, dizziness and palpitation especially after physical activity for 1 month. No other obvious discomforts happened such as fever, backache, dyspnea or hematuria. A remarked rise of blood pressure as high as 200/100 mmHg was found in local hospital 2 weeks ago. Three types of antihypertensive drug including amlodipine, metoprolol, spirolactone were used attaining only a little decrease of blood pressure. Ultrasound examination revealed that the right renal arterial resistant index were increased significantly. In the middle segment of right renal artery a severe stenosis lesion was found through contrast computed tomography (CT). Then, he was referred to our department. The blood pressure was 167/99 mmHg despite antihypertensive medication as physical examination indicated after admitted to our department. The laboratory results including serum creatine and blood urea nitrogen were in normal range.
It was noted that the patient once underwent a laparoscopic procedure 5 months ago. So we reviewed the medical record and operative process of that time. A tumor was found in the right adrenal area by routine ultrasound examination, which was about 81.5 mm × 63.6 mm in size by further CT examination [Figure 1]a. The tumor extended downward and involved the renal vessels [Figure 1]b and c]. The patient did not complain any discomfort at that time. And the physical examination including the blood pressure and laboratory test were unremarkable too. Then, the laparoscopic surgery was performed in order to remove the tumor. During the surgery, it was found that the tumor did not invade surrounding tissue but compressed partially the renal vessels. The renal artery was clamped for a short time when dissecting the lower border of the tumor. The arterial blood pressure remained stable during the operative process. The postoperative recovery was uneventful. And the patient was discharged 3 days later. Gangliocytoma was diagnosed according to pathological finding.
|Figure 1: (a) Computed tomography examination showed a tumor in the adrenal area. (b and c) Computed tomography revealed that the renal vessels were involved. (d) The renal artery angiography showed target narrowing lesion. (e) The angioplasty was performed. (f) The computed tomography angiography showed desirable recanalization at 2 months followup|
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Based on the clinical presentation and past surgical detail, we believed that the RAS of this patient is resulted by an intimal hyperplasia after vascular clamp or constriction by surrounding scar tissue. We administered antiplatelet therapy including aspirin and clopidogrel besides the antihypertensive medication firstly. The, we performed renal artery angioplasty without stenting was carried out [Figure 1]d and [Figure 1]e. The recanalization effect was satisfactory. The blood pressure was normalized to 110/70 mmHg immediately the patient was sent back to the ward. The antihypertensive therapy was discontinued. The antiplatelet therapy was continued in consistent with preoperative prescription. The patient remained normotensive and the recanalisation effect in CT angiography was desirable [Figure 1]f at 2 months followup.
For iatrogenic RVH, abdominal radiotherapy and endovascular operation has been reported commonly as the cause in the literature. Homayoun reported a 63-year-old woman who suffered from RVH after laparoscopic partial nephrectomy. The cause of RAS of this case was attributed to vascular clamp related arterial injury. It is intelligible that the artery of the elderly is more vulnerable to the clamp injury. However, our case's experience indicates that the artery narrowing could happen after laparoscopic procedure in the young. And the RVH of this kind could be solved effectively by balloon angioplasty alone.
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