Bilateral ureteral obstruction following aortic bypass surgery.

A patient developed azotemia from bilateral ureteral obstruction due to retroperitoneal fibrosis after placement of an aortofemoral bypass graft for atherosclerosis in that region. This complication of abdominal vascular prosthesis may be more common than is presently recognized; especially since the patient may remain asymptomatic till an advanced degree to azotemia supervenes. At that time irreversible damage to the kidney may occur. Furthermore, silent damage in the kidneys may be attributed to other causes in these patients who may also have severe vascular disease or prostatic disease. When a gradually increasing azotemia is seen in a patient who had aortofemoral bypass surgery, ureteral obstruction from retroperitoneal fibrosis should be one of the main considerations in the differential diagnosis. Computed tomography, isotope renography and sonography may be helpful in making an early diagnosis and should be a part of the postoperative follow-up care in these patients.