Renovascular Hypertension in a Young Female with Renal Vein Congestion and a Left Renal/Gonadal Vein Aneurysm Successfully Treated with Coiling

Introduction: Secondary hypertension should be suspected among young individuals and patients with recent onset of hypertension or drug-resistant hypertension. Among the causes of secondary hypertension, renovascular hypertension is well-established and correctible if diagnosed appropriately. We report the case of a young female with an unusual cause of renovascular hypertension. Clinical Presentation: A 29-year-old female was admitted for elevated blood pressure and headache, unresponsive to multiple antihypertensives. The workup for secondary hypertension was mostly unremarkable. However, renal Doppler ultrasound showed elevated peak systolic velocity in the left renal artery. CT angiogram revealed an outpouching between the left gonadal and renal veins. No renal artery stenosis was found on renal angiography, but venography revealed an aneurysm between the left gonadal and renal veins. An aberrant vein draining into the inferior vena cava (IVC) and severe reflux into a dilated left gonadal vein were also noted. Management: Endovascular coiling of the aneurysm and left gonadal vein was done, restoring physiologic venous drainage from the left kidney. Blood pressure improved immediately and remained normal without medications one year postoperatively. Conclusion: This case highlights a rare cause of renovascular hypertension due to renal vein congestion from severe left gonadal vein reflux and a renal/gonadal vein aneurysm. Additional mechanisms may include external compression of the renal artery or a suction effect caused by multiple venous outflows. Regardless of the exact pathophysiology, coiling of the aneurysm and gonadal vein successfully restored normal venous return and resolved hypertension. Keywords: Renovascular Hypertension, Gonadal Vein Aneurysm, Renal Vein Aneurysm, Renal Vein Congestion