Endovascular Stent-Graft Repair of Renal Dissection with Expanding Intramural Hematoma Following Renal Artery Stenting

Endovascular Stent-Graft Repair of Renal Dissection with Expanding Intramural Hematoma Following Renal Artery Stenting is an excellent case report, describing a fairly common problem treated in a unique way. Instead of just treating a subintimal dye leak at the site of stent overlap, Shammas et al. wisely analyzed the vessel lumen with intravascular ultrasound, showing that there was an intramural hematoma. The conservative approach paid off with effective therapy, without placement of further stents that may have jeopardized one or two important renal branches supplying the renal parenchyma. The authors describe an interesting example of a patient who had a dissection effectively treated with a covered stent. Finding an area distal to the stent with either a dissection or a significant obstruction lesion, they wisely used intravascular ultrasound (IVUS) to ascertain what was happening at tissue level. This conservative therapy potentially eliminated the risk of obstructing one of the important renal artery side branches. This case is an excellent example of, “if at first you don’t succeed, it is not always best to try, try again.” By using intraluminal diagnostics such as the IVUS, we learn that some things may just take care of themselves.