Sympathetic responses during renal artery occlusion are altered by anesthesia

Purpose: To analyze the renal function and outcome after delayed (>6 hours) endovascular revascularization of acute renal artery occlusion (RAO) in patients with fenestrated-branched endovascular aneurysm repairs (EVARs) or open visceral debranching. Methods: A single-center retrospective analysis was conducted involving 7 patients (mean age 61 years, range 49–72; 5 women) with 9 RAOs treated with endovascular revascularization between December 2014 and March 2017. Three patients had a solitary kidney with chronic renal insufficiency; 1 patient had bilateral occlusions as the acute event. Initial aortic surgery included 5 branched and 1 fenestrated EVAR as well as 1 open visceral debranching operation. Revascularization of the RAO was performed using aspiration thrombectomy, local lysis therapy, and stent-graft relining. The median time between initial aortic surgery and RAO was 10 months (range 0.5–17). Results: Median renal ischemic time to revascularization was 24 hours (range 7–168). Technical success was 100%, with 1 procedure-related access complication. Temporary dialysis dependency occurred in 4 patients. Mean in-hospital stay was 17 days (range 7–32) with 1 postoperative death at day 10 due to cardiac arrest of unknown cause. Mean follow-up was 10.3 months (range 1.5–27) in 5 of 6 discharged patients. During follow-up, 1 reintervention for recurrent occlusion was performed. At follow-up imaging, all renal arteries were patent. No permanent dialysis dependency occurred. Conclusion: Renal function can be salvaged by delayed revascularization for RAO with prolonged renal ischemia. The endovascular approach with aspiration thrombectomy, local lysis, and stent-graft relining is a feasible technique for revascularization after RAO in patients with fenestrated-branched EVAR or open visceral debranching.

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Evaluation of Differential Renal Function Studies in Segmental Renal Artery Occlusion

British Journal of Urology ◽

10.1111/j.1464-410x.1975.tb03957.x ◽

1975 ◽

Vol 47 (3) ◽

pp. 243-252

Author(s):

ALPHONSE PFAU ◽

SHLOMO RAZ ◽

ELIEZER ROSENMANN ◽

ARMIN SCHWARTZ

Keyword(s):

Renal Function ◽

Renal Artery ◽

Artery Occlusion ◽

Differential Renal Function ◽

Renal Artery Occlusion ◽

Segmental Renal Artery

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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Journal of Visualized Experiments ◽

10.3791/62230 ◽

2021 ◽

Author(s):

Ilias P. Doulamis ◽

Alvise Guariento ◽

Mossab Y. Saeed ◽

Rio S. Nomoto ◽

Thomas Duignan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Animal Model ◽

Renal Artery ◽

Kidney Injury ◽

Artery Occlusion ◽

Large Animal Model ◽

Large Animal ◽

Renal Artery Occlusion ◽

Bilateral Renal Artery

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Characterization of the postocclusive response of renal blood flow in the cat

AJP Renal Physiology ◽

10.1152/ajprenal.1978.235.4.f286 ◽

1978 ◽

Vol 235 (4) ◽

pp. F286-F290 ◽

Cited By ~ 3

Author(s):

W. S. Spielman ◽

H. Osswald

Keyword(s):

Blood Flow ◽

Angiotensin Ii ◽

Renal Artery ◽

Renal Blood Flow ◽

Artery Occlusion ◽

Renal Nerves ◽

Vasoconstrictor Response ◽

Renal Artery Occlusion ◽

Chronic Denervation

In contrast to the postocclusive hyperemia of brain, heart, and skeletal muscle, the hemodynamic response of the kidney following renal artery occlusion is highly variable in that both hyperemia and ischemia have been reported. The present study evaluates the factors influencing the renal response to complete renal artery occlusion (5-60 s) in the anesthetized cat. Marked postocclusive vasoconstriction could only be domonstrated in meclofenamate-treated (10 mg/kg) cats. The delta% renal blood flow (RBF) (30-s occlusion) was 16 +/- 4 in controls and 54 +/- 4 after meclofenamate (n= 10; P less than 0.001). Chronic denervation of the kidney, alpha-adrenergic receptor blockade, or infusion of [Sar1, Ile8]angiotensin II(2 microgram/min per kg) did not affect the postocclusive reduction of RBF, indicating that the vasoconstriction was independent of renal nerves, catecholamines, and circulating angiotesin II. Adenosine injected into the renal artery of five cats caused a dose-dependent transient fall of RBF. A dose of 100 nmol adenosine reduced RBF by 44 +/- 6% whereas after meclofenamate only 1 nmol produced the same degree of vasoconstriction. In summary, this study demonstrates a marked potentiation of the postocclusive vasoconstrictor response and the vasoconstrictive action of adenosine by meclofenamate in the anesthetized animal. No evidence was obtained to support a role for the sympathetic nervous system or circulating angiotensin II in mediating the postocclusive vasoconstriction.

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