Anaesthetic Challenges In A Patient With Takayasu Arteritis And Bilateral Renal Artery Stenosis Undergoing Left Laparoscopic Nephrectomy: A Case Report

Abstract

3a Introduction: What is unique about this case and what does it add to the scientific literature?

Takayasu arteritis is a rare, chronic, granulomatous vasculitis involving the aorta and its major branches. Anaesthetic management in these patients is particularly challenging when complicated with bilateral renal artery stenosis, severe hypertension, altered hemodynamics, and end-organ hypoperfusion. Laparoscopic surgery further increases the risk because of pneumoperitoneum-induced hemodynamic changes.

3b Main symptoms and important clinical findings:

A 23-year-old female patient came with c/o headache, palpitations and significant clinical findings included absent bilateral lower limb pulsation.

3c Main diagnoses, therapeutic interventions and outcome:

A 23-year-old female diagnosed with Takayasu arteritis and severe hypertension secondary to bilateral renal artery stenosis (complete occlusion of the left renal artery and 50% stenosis of the right renal artery) was posted for elective laparoscopic left nephrectomy. Anaesthetic management included general anaesthesia with invasive arterial pressure monitoring, BIS monitoring and ultrasound-guided bilateral quadratus lumborum blocks for analgesia. Intraoperatively, Low-pressure pneumoperitoneum and careful hemodynamic management were done to maintain organ perfusion. However, during renal pedicle handling, hypertensive crises (systolic BP >240 mmHg, Diastolic BP>110 mmHg) with transient ST changes occurred and it was managed with titrated nitroglycerin infusion. The perioperative course was managed successfully, and the patient had a stable postoperative recovery.

3d Conclusion:

Patients with takayasu arteritis and bilateral renal artery stenosis undergoing laparoscopic surgery require meticulous perioperative planning, invasive monitoring, and individualized hemodynamic management to prevent catastrophic complications. Regional analgesia, stress-dose steroid supplementation, and multidisciplinary coordination plays a pivotal role in optimizing outcomes.