Spot diagnosis 22



This 65 year old man suffers from severe peripheral vascular disease including an abdominal aortic aneurysm with bilateral ureteral obstruction. This was initially treated by bilateral DJ stenting and systemic prednisolone which did not have any effect on the obstruction. In 2010, a transfemoral aortic stent was successfully inserted into the infrarenal aortic aneurysm. Over the following years, two attempts to permanently remove the ureteral stents with continued prednisolone treatment failed. With stent in situ, the patient is well, serum creatinine is 163 mmol/l and renal paranchyma is as shown on above CT scan. The patient is tired of having to undergo regular changing of stents and would prefer a definitive soulution.

What management options are advisable?

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