MO173SPONTANEOUS RENAL ARTERY DISSECTION (SRAD): IS IT REALLY SO RARE?

Abstract Introduction. Spontaneous Renal Artery Dissection (SRAD) is a rare and often unrecognized clinical entity, which only accounts for 1-2% of all arterial dissections. Due to its rarity, it may be difficult to diagnose and treat. Methods. All patients affected by SRAD and admitted in our Unit in the last year were included. Results. Five patients presented with renal infarction due to SRAD were admitted in our Unit in 2020. Patient Characheristics are shown in Table 1. At onset, all suffered from abdominal pain and high blood pressure. In all patients renal function was normal. Abdomen computed tomography angiography (CTA) was diagnostic in all patients (Figure 1). They were treated with antihypertensive drugs and systemic anticoagulation followed by oral anticoagulants. At 3 month-follow-up, all patients became normotensive and partial or total renal artery recanalization were found (Figure 2). Conclusions. In our experience, SRAD seems to be not very rare in young and healthy patients with minimal comorbidities. Abdomen CTA is one of the “gold standard” non invasive diagnostic method. In patient treated with conservative medical therapy renal outcome is favourable. More studies are necessary to find underlying causes.

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Spontaneous renal artery dissection: an elusive diagnosis

BMJ Case Reports ◽

10.1136/bcr-2021-245949 ◽

2021 ◽

Vol 14 (9) ◽

pp. e245949

Author(s):

Catherine Mary Henry ◽

Peter MacEneaney ◽

Gemma Browne

Keyword(s):

Renal Artery ◽

Antihypertensive Treatment ◽

Rare Condition ◽

Acute Onset ◽

Flank Pain ◽

Artery Dissection ◽

Renal Infarction ◽

Ct Angiogram ◽

Systemic Anticoagulation ◽

The Right

Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.

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Abstract W P223: Treatment of Cervical Artery Dissection with Different Antithrombotic Agents

Stroke ◽

10.1161/str.45.suppl_1.wp223 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Fan Z Caprio ◽

Deborah Bergman ◽

Yvonne Curran ◽

Richard Bernstein ◽

Shyam Prabhakaran

Keyword(s):

Recurrent Stroke ◽

Oral Anticoagulants ◽

Antiplatelet Agents ◽

Novel Oral Anticoagulants ◽

Bleeding Complications ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Cervical Artery ◽

Hemorrhagic Complications

Background and Purpose: Antiplatelet agents and anticoagulants are both accepted and commonly used agents for treatment of cervical artery dissection (CAD), though randomized clinical trials are lacking. We report on the use of novel oral anticoagulants for CAD and compared their efficacy and safety to traditional anticoagulants. Methods: We retrospectively identified patients diagnosed with CAD at a single academic center between July 2010 and December 2012. Patients treated with novel anticoagulants (NOAC: dabigatran or rivaroxaban), other anticoagulants (AC: warfarin, heparin, or low molecular weight heparin), or antiplatelet agents (AP: aspirin, clopidogrel, or aspirin-dypyridamole) were compared for baseline characteristics, recurrent stroke, vessel recanalization on follow-up, and bleeding complications using Fisher’s exact and student t-tests. Results: During the study period, 110 patients with CAD were included, of whom 20 (18%), 61 (55%), and 29 (26%) were treated initially with a NOAC, AC, and AP, respectively. Clinical follow-up was available in 98 (89.1%) patients while radiographic follow-up was available in 88 (80%) patients. NOAC-treated patients were more likely to have presented with ischemic stroke symptoms (90% vs. 55.7%, p=0.007) but had similar rates of severe stenosis (60% vs. 53.3%, p=0.522) and intraluminal/intramural thrombus (70% vs. 57.6%, p=0.327) on initial vascular imaging compared to AC patients. There was 1 recurrent stroke in the NOAC group and 1 in the AC group. Similar proportions of patients had resolved or improved stenosis on follow-up imaging (NOAC: 66.7 vs. AC: 63.3%, p=0.217). Hemorrhagic complications were more likely to occur in AC compared to NOAC patients (17.0% vs. 0%, p=0.019). Conclusion: In this retrospective study, use of novel oral anticoagulants for CAD was associated with similar rates of recurrent stroke and vessel recanalization on follow-up imaging but with fewer hemorrhagic complications. Given their safety profile, NOACs may be a reasonable alternative to traditional anticoagulants in CAD. Prospective validation of these findings is needed.

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Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings

Journal of Korean Medical Science ◽

10.3346/jkms.2017.32.4.605 ◽

2017 ◽

Vol 32 (4) ◽

pp. 605 ◽

Cited By ~ 3

Author(s):

Kibo Yoon ◽

Soon-Young Song ◽

Chang Hwa Lee ◽

Byung-Hee Ko ◽

Seunghun Lee ◽

...

Keyword(s):

Renal Artery ◽

Artery Dissection ◽

Renal Infarction ◽

Acute Renal Infarction

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Unilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension

Italian Journal of Medicine ◽

10.4081/itjm.2015.544 ◽

2015 ◽

Vol 9 (4) ◽

pp. 362

Author(s):

Aurelio Negro ◽

Rosaria Santi ◽

Antonio Manari ◽

Franco Perazzoli

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Renal Denervation ◽

Antihypertensive Drugs ◽

Renal Sympathetic Denervation ◽

Caucasian Woman ◽

Left Renal Artery ◽

Refractory Hypertension ◽

The Mean

A 52-year-old Caucasian woman with essential resistant and refractory hypertension despite optimal medical therapy, including 6 different antihypertensive drugs was referred for the catheter-based renal denervation. Due to unfavourable anatomy because of non-critical fibromuscular dysplasia on the right renal artery, renal denervation of only the left renal artery was performed. Before and after the renal denervation, the patient’s blood pressure was monitored by office measurements and ambulatory blood pressure measurements (ABPM). Before the procedure, the mean office blood pressure was 157/98 mmHg; at ABPM, the mean blood pressure values were 145/94 mmHg. At 6 months of follow-up, the mean office blood pressure was 134/90 mmHg and 121/76 mmHg at ABPM. In latest 12 months of follow-up, office and ABPM blood pressure were 125/80 and 127/80 mmHg respectively. This unique case suggests that unilateral renal denervation may be effective in lowering blood pressure in patients with refractory hypertension and unfavorable renal arteries anatomy.

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Revascularization Versus Medical Therapy for Renal Artery Stenosis: Antihypertensive Drugs and Renal Outcome

Angiology ◽

10.1177/0003319710371615 ◽

2010 ◽

Vol 62 (1) ◽

pp. 92-99 ◽

Cited By ~ 15

Author(s):

Rosario Cianci ◽

Paola Martina ◽

Francesca Borghesi ◽

Domenico di Donato ◽

Lelio Polidori ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Medical Therapy ◽

Antihypertensive Drugs ◽

Artery Stenosis ◽

Renal Outcome

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Renal Artery Dissection Causing Renal Infarction in Otherwise Healthy Men

The Journal of Urology ◽

10.1016/s0022-5347(01)62852-0 ◽

1998 ◽

Vol 160 (3 Part 1) ◽

pp. 953-954

Author(s):

A. Alamir ◽

D.F. Middendorf ◽

P. Baker ◽

N.S. Nahman ◽

A.B. Fontaine ◽

...

Keyword(s):

Renal Artery ◽

Artery Dissection ◽

Renal Infarction ◽

Healthy Men

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Renal artery aneurysms

Atherothrombosis Journal ◽

10.21518/2307-1109-2021-11-1-164-174 ◽

2021 ◽

pp. 164-174

Author(s):

A. E. Zotikov ◽

Z. A. Adyrkhaev ◽

A. M. Solovyova

Keyword(s):

Blood Flow ◽

Surgical Treatment ◽

Arterial Hypertension ◽

Renal Artery ◽

Renal Blood Flow ◽

Antihypertensive Drugs ◽

Renal Parenchyma ◽

Artery Dissection ◽

Childbearing Age ◽

Ehlers Danlos Syndrome

Renal artery aneurysms are a rare condition and are usually found when other abdominal organ diseases are being searched. Among the causes of renal artery aneurysms, atherosclerosis and fibromuscular dysplasia predominate. However, they can also be observed in congenital Ehlers-Danlos syndrome, neurofibromatosis, arteritis, and due to traumatic effects. Most patients have an asymptomatic course of the disease. Literature data suggest slow growth of aneurysms, and their progression is associated with arterial hypertension, absence of wall calcification and pregnancy in young women. The aim of surgical treatment is to prevent aneurysm rupture, eliminate the risk of renal parenchyma embolism and correct arterial hypertension. Most authors believe that surgical treatment is indicated for asymptomatic course of the disease when the aneurysm is over 20 mm in diameter, aneurysm growth is over 5 mm within a year, arterial hypertension resistant to drug therapy, renal artery dissection and aneurysm presence in women of childbearing age. There are a number of surgical and endovascular techniques to restore renal blood flow. Both open and endovascular interventions are used for renal artery trunk surgery. For aneurysms of the renal artery branches, aortorenal shunting by autovenous or internal iliac artery as well as extracorporeal surgeries are more often used. The use of endografts is most appropriate for localization of aneurysms in the renal artery trunk, while embolization with microspirals and glue is most effective for saccular aneurysms. The embolization technique can cause embolization of the renal parenchyma itself as a potential complication, which aggravates arterial hypertension. The authors present the literature and their own data on various techniques to restore the renal blood flow. Up to 80-90% of the operated kidneys can be saved in the long term. Reconstructive surgery reduces the level of arterial pressure and reduces the number of antihypertensive drugs used and the need for renal replacement therapy.

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Renal infarction resulting from traumatic renal artery dissection

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2008.23.2.103 ◽

2008 ◽

Vol 23 (2) ◽

pp. 103-105 ◽

Cited By ~ 6

Author(s):

Kyung Pyo Kang ◽

Sik Lee ◽

Won Kim ◽

Gong Yong Jin ◽

Ki Ryang Na ◽

...

Keyword(s):

Renal Artery ◽

Artery Dissection ◽

Renal Infarction

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Isolated Spontaneous Renal Artery Dissection Presented with Flank Pain

Case Reports in Radiology ◽

10.1155/2015/896706 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Shruti P. Gandhi ◽

Kajal Patel ◽

Bipin C. Pal

Keyword(s):

Computed Tomography ◽

Renal Artery ◽

Ct Angiography ◽

Final Diagnosis ◽

Flank Pain ◽

Vascular Pathology ◽

Artery Dissection ◽

Renal Infarction ◽

Doppler Study ◽

Main Renal Artery

Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction.

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