Introduction
A 62-year-old woman was referred to the cardiology department for evaluation of malignant arterial hypertension refractory to medical management. Remarkable in her medical history were: cigarette smoking over the past 30 years; hyperlipidaemia; uncontrolled arterial hypertension over the past 5 years and bilateral leg intermittent claudication. On admission, blood pressure was 220/140 mmHg. Pulses were absent in and below both femoral arteries. Nevertheless, no signs of acute lower extremity ischaemia were noted. The patient had normal renal function, with creatininaemia of 1.04 mg/dL. Examination of the fundi showed papilloedema and haemorrhage. Computed tomography angiography (CTA) showed complete occlusion of the aorta from the level of renal arteries to both the common iliac arteries, associated with complete occlusion of the right renal artery ( Fig. 1 ). Lower limb and digestive perfusion was assured by an extended collateral vascular network ( Fig. 2 ). The patient was treated with aortobifemoral bypass grafting and right nephrectomy. The postoperative course was uneventful and her blood pressure remained well controlled during follow-up.
