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End stage renal disease caused by thromboangiitis obliterans: a case report.

Yun HJ, Kim DI, Lee KH, Lim SJ, Hwang WM, Yun SR, Yoon SH - J Med Case Rep (2015)

Bottom Line: He also had abdominal angina.Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.But once it occurs, it can be life-threatening.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. yhj0927@kyuh.ac.kr.

ABSTRACT

Introduction: Thromboangiitis obliterans or Buerger's disease is a nonatherosclerotic, segmental, inflammatory vasculitis that is strongly associated with tobacco products and commonly affects the small- and medium-sized arteries of the upper and lower extremities. However, the disease can, rarely, involve large central or visceral arteries. We report here the case of end stage renal disease due to renal artery thrombosis caused by thromboangiitis obliterans.

Case presentation: A 51-year-old Korean man who had previously required amputation of both great toes due to thromboangiitis obliterans presented with left flank pain and oliguria. Both his renal arteries were occluded on contrast-enhanced abdominal computed tomography and abdominal angiography. He also had abdominal angina. He had no risk factor of thromboembolism from cardiac origin, atherosclerosis except for tobacco abuse, collagen diseases or hypercoagulable disorders. Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.

Conclusions: Renal failure due to renal artery thrombosis and mesenteric ischemia represents an unusual manifestation of thromboangiitis obliterans. But once it occurs, it can be life-threatening. When we care for a patient with thromboangiitis obliterans, we should pay attention to this rare disease course, and encourage cessation of the smoking of tobacco products.

No MeSH data available.


Related in: MedlinePlus

Abdominal and lower extremity angiography (2014). a Renal angiography could not identify either renal artery due to total occlusion. b Lower extremity angiography showed a chronic total obstruction lesion of the left common iliac artery due to progression of chronic thrombosis. c A stent was deployed at the site of occlusion of the left common iliac artery (arrow). d Flow was recovered. e Obstruction of the left superficial femoral artery and abnormal corkscrew collateral blood supply from the left deep femoral artery was similar to that seen in 2004 (arrows). f The left tibioperoneal trunk was occluded (arrow), and blood flow below the knee was supplied by collateral vessels
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Fig3: Abdominal and lower extremity angiography (2014). a Renal angiography could not identify either renal artery due to total occlusion. b Lower extremity angiography showed a chronic total obstruction lesion of the left common iliac artery due to progression of chronic thrombosis. c A stent was deployed at the site of occlusion of the left common iliac artery (arrow). d Flow was recovered. e Obstruction of the left superficial femoral artery and abnormal corkscrew collateral blood supply from the left deep femoral artery was similar to that seen in 2004 (arrows). f The left tibioperoneal trunk was occluded (arrow), and blood flow below the knee was supplied by collateral vessels

Mentions: Abdominal and lower extremity angiography was performed to examine his abdominal aorta and lower extremity arteries. The vascular status in both lower limbs and the viscera had worsened. His superior mesenteric artery, inferior mesenteric artery, both renal arteries, left common iliac artery, and left superficial femoral artery were not visualized, and the arteries below both his knees were occluded. Collateral vessels were well developed in his lower extremities. During examination, a stent was inserted into his left common iliac artery (Fig. 3). Upper extremity angiographic CT showed no abnormal findings. His ankle-brachial index was 0.82 on the right and 0.61 on the left.Fig. 3


End stage renal disease caused by thromboangiitis obliterans: a case report.

Yun HJ, Kim DI, Lee KH, Lim SJ, Hwang WM, Yun SR, Yoon SH - J Med Case Rep (2015)

Abdominal and lower extremity angiography (2014). a Renal angiography could not identify either renal artery due to total occlusion. b Lower extremity angiography showed a chronic total obstruction lesion of the left common iliac artery due to progression of chronic thrombosis. c A stent was deployed at the site of occlusion of the left common iliac artery (arrow). d Flow was recovered. e Obstruction of the left superficial femoral artery and abnormal corkscrew collateral blood supply from the left deep femoral artery was similar to that seen in 2004 (arrows). f The left tibioperoneal trunk was occluded (arrow), and blood flow below the knee was supplied by collateral vessels
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4541743&req=5

Fig3: Abdominal and lower extremity angiography (2014). a Renal angiography could not identify either renal artery due to total occlusion. b Lower extremity angiography showed a chronic total obstruction lesion of the left common iliac artery due to progression of chronic thrombosis. c A stent was deployed at the site of occlusion of the left common iliac artery (arrow). d Flow was recovered. e Obstruction of the left superficial femoral artery and abnormal corkscrew collateral blood supply from the left deep femoral artery was similar to that seen in 2004 (arrows). f The left tibioperoneal trunk was occluded (arrow), and blood flow below the knee was supplied by collateral vessels
Mentions: Abdominal and lower extremity angiography was performed to examine his abdominal aorta and lower extremity arteries. The vascular status in both lower limbs and the viscera had worsened. His superior mesenteric artery, inferior mesenteric artery, both renal arteries, left common iliac artery, and left superficial femoral artery were not visualized, and the arteries below both his knees were occluded. Collateral vessels were well developed in his lower extremities. During examination, a stent was inserted into his left common iliac artery (Fig. 3). Upper extremity angiographic CT showed no abnormal findings. His ankle-brachial index was 0.82 on the right and 0.61 on the left.Fig. 3

Bottom Line: He also had abdominal angina.Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.But once it occurs, it can be life-threatening.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine, 158 Gwanjeo-dong-ro, Seo-gu, Daejeon, 302-718, South Korea. yhj0927@kyuh.ac.kr.

ABSTRACT

Introduction: Thromboangiitis obliterans or Buerger's disease is a nonatherosclerotic, segmental, inflammatory vasculitis that is strongly associated with tobacco products and commonly affects the small- and medium-sized arteries of the upper and lower extremities. However, the disease can, rarely, involve large central or visceral arteries. We report here the case of end stage renal disease due to renal artery thrombosis caused by thromboangiitis obliterans.

Case presentation: A 51-year-old Korean man who had previously required amputation of both great toes due to thromboangiitis obliterans presented with left flank pain and oliguria. Both his renal arteries were occluded on contrast-enhanced abdominal computed tomography and abdominal angiography. He also had abdominal angina. He had no risk factor of thromboembolism from cardiac origin, atherosclerosis except for tobacco abuse, collagen diseases or hypercoagulable disorders. Renal failure and mesenteric ischemia associated with thromboangiitis obliterans progression was diagnosed.

Conclusions: Renal failure due to renal artery thrombosis and mesenteric ischemia represents an unusual manifestation of thromboangiitis obliterans. But once it occurs, it can be life-threatening. When we care for a patient with thromboangiitis obliterans, we should pay attention to this rare disease course, and encourage cessation of the smoking of tobacco products.

No MeSH data available.


Related in: MedlinePlus