Renal artery bypass including aortic graft for renovascular hypertension

Background: Renal artery stenosis (RAS) is a rare renal manifestation of tuberous sclerosis (TS). In children, it leads to renovascular hypertension that can be managed medically or surgically. It becomes challenging to treat when other vascular anomalies coexist. Case presentation: A 7-year old Caucasian boy with TS presented with hypertension. Renal angiogram showed left RAS and infrarenal abdominal aortic aneurysm (AAA). After percutaneous transluminal angioplasty (PTA) failed to control his renovascular hypertension, we elected to perform renal artery bypass and aortic graft repair of the AAA. In nine years of follow up, he maintained good blood pressure (BP) control with oral antihypertensive medications and required PTA only once for renal artery bypass graft stenosis. Conclusion: We present a case of TS associated RAS and AAA treated by renal artery bypass and aortic graft repair with favorable outcome. Our surgical approach may delay progression of renal insufficiency in patients with renovascular hypertension and TS.