# Simultaneous Bilateral Renal Revascularization in an Elderly Patient With Recurrent Flash Pulmonary Edema: A Case Report

## TL;DR

An elderly patient with multiple health issues and recurring lung fluid episodes was successfully treated with a procedure to open blocked arteries in both kidneys.

## Contribution

This case report demonstrates the effectiveness of simultaneous bilateral renal revascularization in managing severe bilateral renal artery stenosis in a high-risk elderly patient.

## Key findings

- Bilateral renal artery stenosis was identified as the cause of recurrent pulmonary edema and refractory hypertension.
- Renal revascularization led to improved renal function, controlled blood pressure, and no further pulmonary edema episodes at one-year follow-up.
- The procedure was performed safely with nephroprotective measures to prevent contrast-induced nephropathy.

## Abstract

Renal artery stenosis (RAS) is a well-established cause of secondary hypertension and progressive chronic kidney disease (CKD), and severe bilateral disease may precipitate recurrent episodes of acute heart failure, including flash pulmonary edema, particularly in elderly patients with multiple cardiovascular comorbidities. This report highlights the diagnostic approach, therapeutic strategy, and outcomes in a complex patient with multiple comorbidities. A 78-year-old woman with multiple comorbidities, including hypertension, insulin-dependent diabetes mellitus, dyslipidemia, asthma, peripheral arterial disease, spherocytosis, and chronic kidney disease, presented with recurrent episodes of acute pulmonary edema (APE) initially attributed to heart failure with preserved ejection fraction (HFpEF). Transthoracic echocardiography showed grade II diastolic dysfunction, pulmonary hypertension, and mild valvular disease. Coronary catheterization excluded significant obstructive coronary artery disease, whereas renal angiography revealed severe bilateral renal artery stenosis (right: 65%, left: 80%-90%), associated with worsening renal function and refractory hypertension. Given the high-risk clinical phenotype, the patient underwent bilateral renal artery angioplasty with stent placement, following nephroprotective measures due to the elevated risk of contrast-induced nephropathy. The procedure was uneventful with good angiographic results. At one-year follow-up, no further episodes of pulmonary edema occurred, renal function improved, blood pressure was well controlled, and renal arteries remained patent on ultrasound. This case highlights the importance of evaluating renal artery stenosis in patients with sudden or recurrent acute pulmonary edema, refractory hypertension, or progressive renal dysfunction, particularly in the presence of multiple comorbidities. Bilateral renal revascularization was effective in stabilizing renal function and improving blood pressure control; however, long-term follow-up remains essential.