scholarly journals Accessory polar renal artery not pre-operatively visualized at extra-peritoneal para-aortic lymphadenectomy

2019 ◽  
Vol 29 (7) ◽  
pp. 1226-1227 ◽  
Author(s):  
Melisa Madsen ◽  
Mikel Gorostidi ◽  
Ruben Ruiz ◽  
Ibon Jaunarena ◽  
Paloma Cobas ◽  
...  
Keyword(s):  
Renal Artery ◽  
Endometrial Adenocarcinoma ◽  
Vena Cava ◽  
Vascular Complications ◽  
Renal Arteries ◽  
Vascular Anomalies ◽  
Final Report ◽  
Imaging Studies ◽  
Pelvic Mri ◽  
The Right

The objective of this video is to describe the technique of extra-peritoneal para-aortic laparoscopic lymphadenectomy and emphasize potential vascular risks that should be taken into account during the procedure.The procedure was performed at Donostia University Hospital, a tertiary referral and educational center in San Sebastián, Spain.A 58-year-old woman, body mass index 25.4 kg/m2, G2P2, with a diagnosis of intermediate-risk endometrial adenocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) IBG2 based on pre-operative endometrial histology and pre-operative magnetic resonance imaging (MRI), but upstaged to high-risk endometrial adenocarcinoma on final report (IBG3). In our hospital, risk stratification is based on pelvic MRI (myometrial invasion, cervical invasion) and biopsy (histology and grade) to tailor surgery. Computed tomography (CT) scan pre-operatively is only performed for type 2 endometrial carcinoma and grade 3 histologies.The local institutional review board was consulted, which confirmed that the study was exempt from requiring approval.The patient underwent an extra-peritoneal para-aortic laparoscopic lymphadenectomy, trans-peritoneal bilateral pelvic lymphadenectomy, and a total hysterectomy and bilateral salpingo-oophorectomy.It is mandatory to check pre-operative imaging studies in order to identify vascular anomalies that are not uncommon and may increase the risk of vascular complications.1 Frequently these vascular anomalies, such as a retro-aortic left renal vein, or a double vena cava or left vena cava, may be a casual finding in the pre-operative study, and often such findings are not reported by the radiologist. It is vitally important that the surgeon checks for and identifies any such anomolies, as the risk of complications may be decreased if anomalies of this type are detected pre-operatively.In addition, in the case of existing polar renal arteries, these are frequently not identified in the pre-operative study,2 leading to a risk of injury and partial renal necrosis. There are several anatomical variations of the renal arteries, with an aortic lower polar artery found in 3% of cadavers and 1% of patients on CT, more frequently on the right side.3 Renovascular hypertension4 secondary to an injury of an accessory polar renal artery (APRA) has also been described.Although vascular anomalies, especially venous ones, are more frequently found at the infra-renal left level, in this video we show access to the right side of the dissection and the care that needs to be taken in order not to damage a vascular structure at this level. Special caution is required with the right side of the dissection so as not to injure any perforating veins, including Fellow's vein, when pushing all the nodes to the roof of the dissection.The dissection maneuvers are fine and blunt, establishing bridges of tissue to be sectioned, and thus identifying vascular structures, such as a right APRA that is to be identified and preserved.The surgeon must have a good knowledge of retro-peritoneal vascular anatomy, they should examine pre-operative imaging studies to check for vascular anomalies, and they need to possess an accurate surgical technique to avoid potential vascular injury during laparoscopic para-aortic lymphadenectomy.

Ex Vivo Repair of a Renal Artery Saccular Aneurysm in a Living-Nonrelated Donor and Subsequent Successful Kidney Transplantation

2018 ◽  
Vol 52 (6) ◽  
pp. 455-458
Author(s):  
Rogerio A. Muñoz-Vigna ◽  
Javier E. Anaya-Ayala ◽  
Juan N. Ramirez-Robles ◽  
Daniel Nuño-Diaz ◽  
Sandra Olivares-Cruz
Keyword(s):  
Kidney Transplantation ◽  
Renal Artery ◽  
Ex Vivo ◽  
Incidental Finding ◽  
Left Kidney ◽  
Renal Arteries ◽  
Saccular Aneurysm ◽  
Preoperative Imaging ◽  
The Right ◽  
Stage Renal Disease

The use of kidney grafts with aneurysmal disease involving the renal arteries for transplantation is very uncommon and relatively controversial. We herein present the case of a 52-year-old woman who volunteered to become a living-nonrelated donor; during the preoperative imaging workup, a computed tomography angiography revealed a 1.5-cm saccular aneurysm in the left kidney, while the contralateral renal artery was normal. We decided to utilize the left kidney for a 25-year-old male patient with end-stage renal disease, and following the ex vivo repair using the recipient epigastric vessels and saphenous veins, we completed the transplantation in the right pelvic fossa. The postoperative period was uneventful, and at 8 months from the surgery, the graft remains functional. The surgical repair of renal artery aneurysms followed by immediate kidney transplantation is a safe technique and an effective replacement therapy for recipients. The incidental finding of isolated aneurysmal disease in renal arteries should not exclude graft potential availability for transplantation following repair.

scholarly journals Origin, Traject and Distribution of Renal Arteries (Arteriae renalis) in Chinchilla lanigera

2018 ◽  
Vol 75 (1) ◽  
pp. 129
Author(s):  
Cristian MARTONOS ◽  
Cristian DEZDROBITU ◽  
Florin STAN ◽  
Aurel DAMIAN ◽  
Alexandru GUDEA
Keyword(s):  
Renal Artery ◽  
Renal Arteries ◽  
Left Renal Artery ◽  
Lateral Part ◽  
Formaldehyde Solution ◽  
Anatomical Dissection ◽  
The Right ◽  
High Degree ◽  
Aorta Abdominalis ◽  
Degree Of Similarity

For the present study a number of 5 female chinchilla carcasses were used. The animals were slaughtered for commercial purpuses (fur). The anatomical dissection started with the identification of the aorta (Aorta abdominalis). The next step was the intra-arterial injection of a colouring substance. The carcasses was fixed in the formaldehyde solution and subsequently the renal arteries were dissected. The first renal artery was the right renal artery (Arteria renalis dextra) and, at 0,5 cm caudally, the left renal artery (Arteria renalis sinister) arose . The origin of those arteries were disposed on the lateral part of the abdominal aorta.The origin, traject and distribution of renal arteries on the studied species have a high degree of similarity with the literature dates described for leporids.

Cardiac Pulsatility– and Respiratory-Induced Deformations of the Renal Arteries and Snorkel Stents After Snorkel Endovascular Aneurysm Sealing

2019 ◽  
Vol 26 (4) ◽  
pp. 556-564
Author(s):  
Christopher P. Cheng ◽  
Ga-Young Suh ◽  
John J. Kim ◽  
Andrew Holden
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Left Renal Artery ◽  
3 Dimensional ◽  
Maximum Curvature ◽  
Mechanical Durability ◽  
The Right ◽  
Aneurysm Repair

Purpose: To quantify deformations of renal arteries and snorkel stents after snorkel endovascular aneurysm sealing (Sn-EVAS) resulting from cardiac pulsatility and respiration and compare these deformations to patients with untreated abdominal aortic aneurysms (AAA) and snorkel endovascular aneurysm repair (Sn-EVAR). Materials and Methods: Ten Sn-EVAS patients (mean age 75±6 years; 8 men) were scanned with cardiac-gated, respiration-resolved computed tomography angiography. From 3-dimensional geometric models, changes in renal artery and stent angulation and curvature due to cardiac pulsatility and respiration were quantified. Respiration-induced motions were compared with those of 16 previously reported untreated AAA patients and 11 Sn-EVAR patients. Results: Renal artery bending at the stent end was greater for respiratory vs cardiac influences (6°±7° vs −1°±2°, p<0.025). Respiration caused a 3-fold greater deformation on the left renal artery as compared with the right side. Maximum curvature change was higher for respiratory vs cardiac influences (0.49±0.29 vs 0.24±0.17 cm−1, p<0.025), and snorkel renal stents experienced similar maximum curvature change due to cardiac pulsatility and respiration (0.14±0.10 vs 0.19±0.09 cm−1, p=0.142). When comparing the 3 patient cohorts for respiratory-induced deformation, there was significant renal branch angulation in untreated AAAs, but not in Sn-EVAR or Sn-EVAS, and there was significant bending at the stent end in Sn-EVAR and Sn-EVAS. Maximum curvature change due to respiration was ~10-fold greater in Sn-EVAR and Sn-EVAS compared to untreated AAAs. Conclusion: The findings suggest that cardiac and respiratory influences may challenge the mechanical durability of snorkel stents of Sn-EVAS; similarly, however, respiration may be the primary culprit for tissue irritation, increasing the risk for stent-end thrombosis, especially in the left renal artery. The bending stiffness of snorkel stents in both the Sn-EVAR and Sn-EVAS cohorts damped renal branch angulation while it intensified bending of the artery distal to the snorkel stent. Understanding these device-to-artery interactions is critical as they may affect mechanical durability of branch stents and quality and durability of treatment.

Improved Technique for Aorto-Renal Reconstruction: A Haemodynamic Approach

1973 ◽  
Vol 45 (s1) ◽  
pp. 315s-316s
Author(s):  
U. Ruberti ◽  
A. Vegeto ◽  
E. Malan
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Vena Cava ◽  
Artery Stenosis ◽  
Improved Method ◽  
End To End ◽  
Renal Reconstruction ◽  
The Right ◽  
Improved Technique

1. An improved method of aorto-renal reconstruction in renal artery stenosis is described. 2. The Dacron prosthesis is inserted high in the aorta, thus avoiding a recurrent course and limiting turbulence. 3. The prosthesis is inserted end-to-end in the reconstructed renal artery. 4. On the right side the restructured renal artery is placed anterior to the vena cava. 5. These modifications result in a wide anastomosis with maximum haemodynamic effectiveness.

scholarly journals Arterial Pattern of The Kidney In A Bangladeshi Population - A Postmortem Study

2016 ◽  
Vol 24 (1) ◽  
pp. 12-16
Author(s):  
Fatema Johora ◽  
Abu Sadat Mohammad Nurunnabi ◽  
Dilruba Siddiqua ◽  
Hosna Ara Perven ◽  
Shamim Ara
Keyword(s):  
Renal Artery ◽  
Age Groups ◽  
Renal Arteries ◽  
Branching Pattern ◽  
Renal Angiography ◽  
Medical College ◽  
Group A ◽  
Bangladeshi Population ◽  
The Right ◽  
Accessory Renal Arteries

Context: The kidney is a highly vascular organ in the human body. The aim of the present study was to see the variations in perihilar branching pattern and morphology of the main renal arteries in a Bangladeshi population based on autopsy.Methods: This cross-sectional, descriptive study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from July 2008 to June 2009, based on collection of 140 post mortem human kidneys from 70 unclaimed dead bodies which were in the morgue. All the samples were divided into three age-groups: A (10-19 years), B (20-39 years) and C (40-59 years). Morphological examination was done to identify main renal arteries and accessory renal arteries with their sites of origin and perihilar branching pattern of the renal arteries as well. The length of the renal artery was measured by using a measuring tape. Besides, renal angiography was done to see the intrarenal branching pattern.Results: The length of the right and left renal arteries were found 3.09±0.08 cm and 2.09±0.09 cm; 3.48±0.17 cm and 2.34±0.17 cm; 3.88±0.17 cm and 2.81±0.16 cm in group A, B and C respectively. The length of the right renal artery was found greater than of the left (P<0.001) in all age-groups. Besides, age related changes were also found in the length of the renal arteries (P<0.001). Accessory renal arteries were present in the right side in 33.4%, 23.35 and 33.3% specimens in group A, B and C respectively, while in the left side, in 59.7%, 27.9% and 13.4% in group A, B and C respectively. The number of anterior divisions of the both renal arteries were 2 in 8.3%, 3 in 12.5% and 4 in 79.2% specimens in group A, while in group B, 2 in 7%, 3 in 17.4% and 4 in 75.6% specimens, and in group C, 2 in 3.3%, 3 in 3.3% and 4 in 93.3% specimens. Number of posterior division was found only 1 in all the groups. Renal angiography revealed intrarenal branching pattern which showed segmental arteries divided into several lobar arteries and interlobar arteries.J Dhaka Medical College, Vol. 24, No.1, April, 2015, Page 12-16

scholarly journals METHOD FOR DESIGNING SURGICAL ACCESS FOR ADRENALECTOMY USING 3D-MODELING

2020 ◽  
Vol 23 (2) ◽  
pp. 165-171
Author(s):  
P. N. Romashchenko ◽  
I. S. Zheleznyak ◽  
N. A. Maistrenko ◽  
S. G. Bliumina
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Left Kidney ◽  
Three Dimensional ◽  
Vena Cava ◽  
Vascular Complications ◽  
Risk Criteria ◽  
Surgical Access ◽  
Preoperative Ct ◽  
The Right

In the literature, insufficient attention is paid to the preoperative planning of the approach to adrenal glands using the modern capabilities of computed tomography (CT) navigation. The aim of the work was to demonstrate the possibilities of designing safe access for adrenalectomy using three-dimensional printed models based on preoperative CT data. The possibilities of preoperative access design for edrenalectomy were studied in 362 adrenal tumor patients who underwent CT imaging on Aquillion 64 (Toshiba, Japan), followed by post-processor image processing, construction of multi-plane and 3D reconstructions. All patients were divided into retrospective (n=157) and prospective (n=205) groups. In 3 clinical cases, preoperative access design was supplemented by the creation of a three-dimensional printed model of the adrenal gland with a tumor using the Slicer 4.10.1 software. Reliable anthropometric (body mass index, body shape) and CT-criteria for designing surgical access to the left and right adrenals were determined: diameter of formation; tumor syntopy in relation to the walls of the inferior vena cava; the length of the central adrenal vein and the place where it flows into the inferior vena cava; the location of the tumor relative to the inferior vein of the right lobe of the liver, as well as relative to the gate of the right kidney; location near the aortic-renal vascular triangle, gate of the left kidney and spleen vessels. Three patients with a borderline number of risk criteria for the development of vascular complications associated with the technical difficulties of adrenalectomy (for right adrenals≥4, for left adrenals≥3) underwent CT-segmentation of images with the subsequent creation of three-dimensional plates - a model of an NP tumor with neighboring organs and vessels. Preoperative CT design of the approach, taking into account the risk criteria for complications and the use of 3-D printed models, can reasonably apply endoscopic and open options for adrenalectomy, significantly improving the immediate results of treatment of patients.

scholarly journals Renal artery injury during inferior vena cava filter removal with endobronchial forceps

2019 ◽  
Vol 8 ◽  
pp. 204800401989351
Author(s):  
Carlos A Padula ◽  
Andrew R Lewis ◽  
Gregory T Frey ◽  
J Mark McKinney ◽  
Ricardo Paz-Fumagalli ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Renal Artery ◽  
Inferior Vena ◽  
Vena Cava ◽  
Arterial Injury ◽  
Artery Injury ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters ◽  
Stent Graft Repair ◽  
The Right

Retrieval of tip-embedded inferior vena cava filters using endobronchial forceps is a well-described technique. The tip of dorsally tilted filters may be in proximity to the right renal artery, increasing the risk of arterial injury during retrieval. We present one case that illustrates renal artery injury requiring emergent stent graft repair. The three subsequent cases illustrate techniques that avoid renal artery injury using a femoral and jugular approach with the assistance of an arterial fiducial wire. Renal artery injury is a potential complication during retrieval of filters using endobronchial forceps that can be prevented with careful planning.

Experimental Analysis of Transvenous Ultrasonography in Localizing and Grading Renal Artery Stenosis

Vascular ◽  
2004 ◽  
Vol 12 (5) ◽  
pp. 301-306
Author(s):  
Albeir Mousa ◽  
Joshua Bernheim ◽  
Rajeev Dayal ◽  
Jonathan Deitch ◽  
Peter Henderson ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Effective Means ◽  
Vena Cava ◽  
The United States ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Model Study ◽  
Animal Model Study ◽  
Stenotic Lesions

This study evaluated the potential for transvenous ultrasonography to assess renal artery stenosis (RAS), the most common correctable cause of hypertension in the United States. We developed a porcine model for studying RAS using TVUS. An endovascular ultrasound probe was placed into the inferior vena cava and renal veins to image renal arteries in which stenoses had been surgically created in varied locations and to varied degrees. TVUS was then used to identify and assess these stenotic lesions. The accuracy of TVUS for determining the degree and location of the stenoses was then determined using contrast arteriography as the standard. When compared with arteriography, TVUS identified and properly located all six lesions and correctly quantified the degree of stenosis in five of the six lesions. TVUS is an effective means of assessing the presence, degree, and location of stenotic lesions of the renal arteries in this animal model. Study of this method in humans may be warranted.

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