Quantitative analysis of renal arterial variations affecting the eligibility of catheter-based renal denervation using multi-detector computed tomography angiography

AbstractCatheter-based renal denervation (RDN) was introduced to treat resistant hypertension. However, the reduction in blood pressure after the RDN was modest. Catheter-based RDN was performed only at main renal arteries, except for accessory and branch arteries due to the diameter being too small for the catheter to approach. Here, we retrospectively analyzed the anatomy of diverse renal arteries via 64-channel multi-detector computed tomography angiograms of 314 consecutive donors who underwent living donor nephrectomy from January 2012 to July 2017. Occurrence rates of one or more accessory renal arteries in donors were 25.3% and 19.4% on the left and right sides, respectively. Early branching rates before 25 mm from the aorta to the right and left renal arteries were 13.7% and 10.5%, respectively. Overall, 63.1% and 78.3% of donors had no accessory artery bilaterally and no branched renal artery, respectively. As a result, 47.1% had only main renal arteries without an accessory artery and early-branching artery. Approximately half of the donors had multiple small renal arteries bilaterally, for which catheter-based denervation may not be suitable. Thus, preoperative computed tomography angiography requires careful attention to patient selection, and there is a need for improved methods for denervation at various renal arteries.

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Multiple Renal Arteries: Variations Demonstrated by Multidetector Computed Tomography Angiography

Medical Principles and Practice ◽

10.1159/000316384 ◽

2010 ◽

Vol 19 (5) ◽

pp. 412-414 ◽

Cited By ~ 4

Author(s):

Mustafa Koplay ◽

Omer Onbas ◽

Fatih Alper ◽

Erim Gulcan ◽

Mecit Kantarci

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Computed Tomography Angiography ◽

Renal Arteries ◽

Multiple Renal Arteries ◽

Multidetector Computed Tomography Angiography

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Variant Anatomy of the Renal Arteries: a Computed Tomography Angiography Study

Journal of Anatomy and Histopathology ◽

10.18499/2225-7357-2020-9-1-43-48 ◽

2020 ◽

Vol 9 (1) ◽

pp. 43-48

Author(s):

A. V. Kolsanov ◽

A. K. Nazaryan ◽

A. S. Voronin ◽

O. A. Gelashvili

Keyword(s):

Computed Tomography ◽

Clinical Practice ◽

Renal Artery ◽

Computed Tomography Angiography ◽

Three Dimensional ◽

Renal Arteries ◽

Software Complex ◽

Three Dimensional Modeling ◽

Dimensional Modeling ◽

Variant Anatomy

The article discusses variant anatomy of the renal arteries, potentials of three-dimensional modeling and use of these data in clinical practice. Despite a large number of studies based on both morphological and clinical approaches there is no general consensus regarding options for dividing the renal artery, the number of its branches, their topolocalization. This is due to the fact that most of the research studies are based on cadaveric material, fixed and unfixed. It is difficult to apply these data to explain medical conditions and pathologies of particular patients. Computed tomography allows performing in vivo investigation of various morphometric parameters of the renal arteries, and these findings can subsequently be used in disease diagnostics and treatment.The aim of the study was to identify patterns of topography, linear dimensions and variant anatomy of the human renal arteries based on computed tomography angiography (CTA) with three-dimensional modeling, and to apply CTA findings in clinical practice.Material and methods. The study included CTA images of the abdomen of 130 patients, and their threedimensional models. A hardware-software complex "Luch-S" and software complex "Avtoplan" (Russian project) were used to perform morphometric analysis. The diameter of the renal artery mouth, the level of origin of the renal artery mouths, as well as the angles between the renal arteries and the abdominal aorta were analyzed morphometrically and statistically.Results. The authors have developed recommendations how to use three-dimensional modeling of vascular- organ complexes in patients at the stage of preoperative planning and intraoperative navigation in clinical practice. Generated dataset of personalized morphometric data can be applied to teach basic operation techniques involving possible damage to abnormal vessels, as well as training specific surgical procedures involving the kidney and its vessels in a simulation-based surgical clinic.

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Endovascular treatment of thoracic aortic diseases: Follow-up and complications with multi-detector computed tomography angiography

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(09)79322-1 ◽

2009 ◽

Vol 2009 ◽

pp. 225-227

Author(s):

T.G. Walker

Keyword(s):

Computed Tomography ◽

Endovascular Treatment ◽

Computed Tomography Angiography ◽

Aortic Diseases ◽

Multi Detector Computed Tomography

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Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism

Vascular ◽

10.1177/1708538116645056 ◽

2016 ◽

Vol 25 (1) ◽

pp. 54-62 ◽

Cited By ~ 2

Author(s):

Kenneth Ouriel ◽

Richard L Ouriel ◽

Yeun J Lim ◽

Gregory Piazza ◽

Samuel Z Goldhaber

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Computed Tomography Angiography ◽

Intraclass Correlation ◽

Left Ventricular ◽

Observer Agreement ◽

Left Ventricular Diameter ◽

The Right

Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

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Renal Denervation of Accessory Renal Arteries

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2013.12.194 ◽

2014 ◽

Vol 7 (3) ◽

pp. 340-341 ◽

Cited By ~ 2

Author(s):

Farrell O. Mendelsohn

Keyword(s):

Renal Denervation ◽

Renal Arteries ◽

Accessory Renal Arteries

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256 Slice Multi-detector Computed Tomography Thoracic Aorta Computed Tomography Angiography

Journal of Computer Assisted Tomography ◽

10.1097/rct.0000000000000456 ◽

2016 ◽

Vol 40 (6) ◽

pp. 964-970 ◽

Cited By ~ 5

Author(s):

Charbel Saade ◽

Fadi El-Merhi ◽

Bassam El-Achkar ◽

Racha Kerek ◽

Thomas J. Vogl ◽

...

Keyword(s):

Computed Tomography ◽

Thoracic Aorta ◽

Computed Tomography Angiography ◽

Multi Detector Computed Tomography

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Innominate artery aneurysm, how to solve it?

Journal of International Medical Research ◽

10.1177/0300060517711087 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1279-1284 ◽

Cited By ~ 4

Author(s):

Xiao-Long Wang ◽

Xin-Liang Guan ◽

Wen-Jian Jiang ◽

Ou Liu ◽

Hong-Jia Zhang

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Work Experience ◽

Median Sternotomy ◽

Artery Aneurysm ◽

Innominate Artery ◽

Ascending Aorta ◽

Dacron Graft ◽

Postoperative Course ◽

The Right

We herein describe our *These authors contributed equally to this work. experience with a congenital innominate artery aneurysm (IAA) that was managed with a simple surgical procedure. A 44-year-old woman was admitted for chest distress. Computed tomography angiography showed a 3.6-cm IAA arising from the aortic arch and compressing the trachea. A median sternotomy was performed with the patient under general anesthesia, and the IAA was found to involve the origin of the innominate artery and the bifurcation of the right subclavian artery and common carotid artery; however, the aorta was intact. An 8-mm Dacron graft was anastomosed to the ascending aorta and distal end of the IAA without cardiopulmonary bypass. The postoperative course was uneventful, and repeat computed tomography angiography revealed no evidence of recurrence 6 months postoperatively. We also herein present a literature review of this rare clinical condition.

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