Hepatorenal Bypass for Renal Salvage: A Forgotten Option in the Endovascular Era

Abstract

Introduction:

In this era of rapidly expanding endovascular techniques, the use of hepatorenal bypass as treatment for a critically compromised renal perfusion has largely been forgotten. This article highlights the benefits of the technique both as a bailout strategy following complications from angioplasty and as a primary treatment in cases deemed unsuitable for endovascular intervention.

Materials and Methods:

Two patients are described whose renal viability was threatened by vascular compromise. One patient had a single functioning kidney with significant renal artery stenosis secondary to severe atherosclerotic disease and developed acute renal function deterioration following unsuccessful angioplasty. The second patient developed renal artery occlusion 3 years following open thoracoabdominal aortic aneurysm surgery. Both patients underwent successful hepatorenal bypass surgery and remain off dialysis 6 months after admission.

Results:

Both cases demonstrated the success of hepatorenal bypass with significant improvement in their renal function following open surgical repair.

Conclusion:

Hepatorenal bypass, although now seldom used because of available endovascular alternatives, remains an effective method of treating complicated cases of threatened kidney secondary to vascular insult.