Renovascular hypertension: endovascular therapy in complicated aortic Stanford type B dissection.

A 63 years old male with a history of arterial hypertension presented with a current onset of chest pain and discrete headaches accompanied with dizziness. His blood pressure, 210/110 mmHg, had worsened and showed a reversed circadian rhythm with an average of 150/90 mmHg during night time. A CT angiography of the aorta demonstrated a type B dissection involving the right renal artery causing reduced perfusion of the right kidney. Subsequent invasive aortic angiography showed a continuously moving aortic dissection flap resulting in a dynamic stenosis proven by varying pressure gradients of between 5 and 35 mmHg. Stent placement of the renal artery ostium kept the vessel open and fixed the reno-aortic dissection flap in order to prevent it from progressing into the right kidney. Follow-up examinations revealed improved blood pressure control allowing for physiologic drop of blood pressure during night-time.