Renal salvage using stent graft placement after acute renal artery occlusion with prolonged ischemic time

Purpose To describe a patient with acute renal artery occlusion who underwent successful revascularization procedure after experiencing a protracted ischemic period, which resulted in successful retrieval of renal function. Case report A 58-year-old male with a history of left renal artery stenosis and stent graft placement presented with symptoms of chest pain, shortness of breath, and flank pain. The patient was admitted to the Intensive Care Unit with the diagnosis of multiorgan failure and subsequent anuria that led to the initiation of hemodialysis. Computed tomography angiography demonstrated an aortic occlusion along with bilateral proximal renal artery occlusion with reconstitution of the mid to distal renal arteries via collateralization. The patient underwent angioplasty with bilateral renal artery stent-graft placement and successful revascularization of proximal renal arteries. Post-operatively, his renal function and urine output improved, and the patient was able to be weaned off hemodialysis along with the benefit of concurrent amelioration of his renovascular hypertension. Conclusion For select patients with renal artery occlusion, revascularization of the renal arteries may result in dialysis independence and stabilization of renovascular hypertension, despite prolonged time of ischemia.

Download Full-text

Renal Function Salvage After Delayed Endovascular Revascularization of Acute Renal Artery Occlusion in Patients With Fenestrated-Branched Endovascular Aneurysm Repair or Visceral Debranching

Journal of Endovascular Therapy ◽

10.1177/1526602818783506 ◽

2018 ◽

Vol 25 (4) ◽

pp. 466-473 ◽

Cited By ~ 3

Author(s):

Franziska Heidemann ◽

Tilo Kölbel ◽

E. Sebastian Debus ◽

Holger Diener ◽

Sebastian W. Carpenter ◽

...

Keyword(s):

Renal Function ◽

Renal Artery ◽

Stent Graft ◽

Aortic Surgery ◽

Artery Occlusion ◽

Aspiration Thrombectomy ◽

Endovascular Revascularization ◽

Renal Artery Occlusion ◽

Local Lysis

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.

Download Full-text

Renal Salvage after Stent Graft Placement after Acute Renal Artery Occlusion with Prolonged Time of Ischemia

Graduate Medical Education Research Journal ◽

10.32873/unmc.dc.gmerj.1.1.041 ◽

2019 ◽

Vol 1 (1) ◽

Keyword(s):

Renal Artery ◽

Stent Graft ◽

Artery Occlusion ◽

Graft Placement ◽

Prolonged Time ◽

Renal Artery Occlusion

Download Full-text

Successful revascularization of the kidney: Case reports

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0410323d ◽

2004 ◽

Vol 132 (9-10) ◽

pp. 323-326

Author(s):

Lazar Davidovic ◽

Radomir Sindjelic ◽

Mirjana Stanojevic ◽

Ilija Kuzmanovic ◽

Momcilo Colic ◽

...

Keyword(s):

Blood Pressure ◽

Renal Failure ◽

Renal Function ◽

Renal Artery ◽

Renovascular Hypertension ◽

Medical Therapy ◽

Case Reports ◽

Artery Occlusion ◽

First Case ◽

Renal Artery Occlusion

Three cases of successful kidney revascularization and recovery of renal function are presented in this study. In all three cases, renal failure and renovascular hypertension were caused by renal artery occlusion associated with aortic aneurysm (two abdominal and one thoracoabdominal). Prior to operation, one patient required dialysis 4 months, one 25 days and one 2 days. After kidney revascularization, renal function recovered immediately in the first case, in the second case after three months, and in the third case after 10 days. In one case, blood pressure restored to normal without medical therapy, while in two other cases blood pressure decreased nearly to normal with minimal medical therapy. In appropriately selected cases, revascularization of the occluded renal artery is recommended for treatment of both renal failure and renovascular hypertension. In such cases, collateral circulation is crucial to enable the preservation of dysfunctional kidney.

Download Full-text

Recovery of Renal Function after Renovascular Surgery

Scottish Medical Journal ◽

10.1177/003693308102600108 ◽

1981 ◽

Vol 26 (1) ◽

pp. 27-31 ◽

Cited By ~ 1

Author(s):

A. Mackay

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Reconstructive Surgery ◽

Severe Hypertension ◽

Artery Occlusion ◽

Unilateral Nephrectomy ◽

Left Renal Artery ◽

Renal Artery Occlusion

A 48-year-old woman with generalised atheromatous disease had a right nephrectomy for a renal artery occlusion in 1977. Fourteen months later she presented with severe hypertension and anuria, caused by occlusion of the left renal artery. Emergency reconstructive surgery was successful in bringing about recovery of renal function and lowering of her blood pressure. Because renal function had deteriorated slightly after the first operation and improved after the second, a comparison was made of the effects of unilateral nephrectomy and reconstructive surgery on renal function in a further 26 patients with renal artery stenosis. In 15 patients having nephrectomy, renal function deteriorated in most, while in 11 having reconstruction it improved in nine and remained constant in two.

Download Full-text

Endovascular Stent-Anchored Aortic Grafts: A Comparison between Self-Expanding and Balloon-Expandable Stents in Minipigs

Journal of Endovascular Therapy ◽

10.1177/152660289600300307 ◽

1996 ◽

Vol 3 (3) ◽

pp. 284-289 ◽

Cited By ~ 3

Author(s):

Mats Lindh ◽

Martin Malina ◽

Krasnodar Ivancev ◽

Jan Brunkwall ◽

Bengt Lindblad

Keyword(s):

Renal Artery ◽

Stent Graft ◽

Artery Occlusion ◽

Renal Arteries ◽

Graft Material ◽

Endovascular Graft ◽

Renal Artery Occlusion ◽

Before And After ◽

Partial Thrombosis ◽

Palmaz Stents

Purpose: To study endovascular graft attachment with self-expanding Gianturco Z-stents and balloon-expanded Palmaz stents and the effect of these devices on the renal ostia. Methods: Ten stent-grafts were constructed, 5 with Gianturco Z-stents and 5 with Palmaz stents. The endografts were implanted under fluoroscopic guidance into the abdominal aorta of 10 pigs so that the uncovered portion of the proximal stent extended over the renal artery orifices. Distal aortic blood pressure and flow were measured before and after graft placement and 1 hour postprocedure. The aorta was then exposed surgically, and the central portion of the stent-graft was inspected through an aortotomy to assess perigraft leakage. Results: Stent-graft implantation was accurate and hemostatic in all cases, despite longitudinal folding of the graft due to oversizing. However, transverse folds produced pressure gradients (> 15 mmHg) between the ends of the graft in two cases. In another case, a pressure gradient resulted from partial thrombosis of the graft. In two cases, renal artery occlusion and thrombosis occurred due to coverage by the graft material. In two other animals, one of the renal arteries was entirely uncovered by a stent. The remaining 16 renal arteries were covered by the proximal stent but not the graft, as intended. One (6.25%) of these arteries thrombosed, but the remainder were grossly patent when the animals were sacrificed at 1 hour. Conclusions: Both Palmaz and Gianturco Z-stents produced hemostatic endovascular graft attachment, even in the presence of moderate graft oversizing. The risk of acute renal artery occlusion from juxtarenal stenting does not appear to be prohibitive, but longer term observations are needed.

Download Full-text

FJVIS 27. Renal Salvage Using Stent Graft Placement After Acute Renal Artery Occlusion With Prolonged Ischema Time

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.08.211 ◽

2019 ◽

Vol 70 (5) ◽

pp. e197-e198

Author(s):

Yue Gao ◽

Dimitrios Miserlis ◽

G. Matthew Longo ◽

Nitin Garg

Keyword(s):

Renal Artery ◽

Stent Graft ◽

Artery Occlusion ◽

Graft Placement ◽

Renal Artery Occlusion

Download Full-text

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

Download Full-text

Restoration of renal function by a novel prostaglandin EP4 receptor-derived peptide in models of acute renal failure

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00138.2012 ◽

2013 ◽

Vol 304 (1) ◽

pp. R10-R22 ◽

Cited By ~ 6

Author(s):

Martin Leduc ◽

Xin Hou ◽

David Hamel ◽

Melanie Sanchez ◽

Christiane Quiniou ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Renal Artery ◽

Artery Occlusion ◽

Hek293 Cells ◽

Heme Oxygenase 1 ◽

Histological Changes ◽

Ep4 Receptor ◽

Renal Artery Occlusion

Acute renal failure (ARF) is a serious medical complication characterized by an abrupt and sustained decline in renal function. Despite significant advances in supportive care, there is currently no effective treatment to restore renal function. PGE2 is a lipid hormone mediator abundantly produced in the kidney, where it acts locally to regulate renal function; several studies suggest that modulating EP4 receptor activity could improve renal function following kidney injury. An optimized peptidomimetic ligand of EP4 receptor, THG213.29, was tested for its efficacy to improve renal function (glomerular filtration rate, renal plasma flow, and urine output) and histological changes in a model of ARF induced by either cisplatin or renal artery occlusion in Sprague-Dawley rats. THG213.29 modulated PGE2-binding dissociation kinetics, indicative of an allosteric binding mode. Consistently, THG213.29 antagonized EP4-mediated relaxation of piglet saphenous vein rings, partially inhibited EP4-mediated cAMP production, but did not affect Gαi activation or β-arrestin recruitment. In vivo, THG213.29 significantly improved renal function and histological changes in cisplatin- and renal artery occlusion-induced ARF models. THG213.29 increased mRNA expression of heme-oxygenase 1, Bcl2, and FGF-2 in renal cortex; correspondingly, in EP4-transfected HEK293 cells, THG213.29 augmented FGF-2 and abrogated EP4-dependent overexpression of inflammatory IL-6 and of apoptotic death domain-associated protein and BCL2-associated agonist of cell death. Our results demonstrate that THG213.29 represents a novel class of diuretic agent with noncompetitive allosteric modulator effects on EP4 receptor, resulting in improved renal function and integrity following acute renal failure.

Download Full-text

The Application of R.E.N.A.L. Nephrometry Score In Laparoscopic Partial Nephrectomy With Zero Ischemia And Sutureless

10.21203/rs.3.rs-1152577/v1 ◽

2021 ◽

Author(s):

Yi Mu ◽

Kehang Chen ◽

Jun He ◽

Peng Chen ◽

Miao Liu ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Renal Function ◽

Renal Artery ◽

Cell Carcinoma ◽

Partial Nephrectomy ◽

Renal Cell ◽

Artery Occlusion ◽

Nephrometry Score ◽

Renal Artery Occlusion ◽

Zero Ischemia

Abstract Background: To evaluate the application of R.E.N.A.L. nephrometry score (RNS) in laparoscopic partial nephrectomy (LPN) with zero ischemia and sutureless surgery, and to explore the efficacy and safety of zero ischemia and seamless LPN in the treatment of renal cell carcinoma.Methods: The clinical data of 67 patients with renal cell carcinoma treated by LPN in the affiliated Hospital of Guizhou Medical University from January 2016 to July 2020 were analyzed retrospectively. The patients were divided into renal artery occlusion group (n=31) and non-occlusion group (n=36). All cases were divided according to their RNS (low, moderate, and high), and the perioperative condition, postoperative complications, postoperative recovery and changes of renal function in the two groups were analyzed.Results: According to the RNS, all cases were classified in low-complex. Both groups successfully completed the operation without operative complications. Compared with the renal artery occlusion group, the non-occlusion group had a shorter operation time (35.51±20.48 min), shorter hospital stay (6.72±4.39 d), and no significant difference in intraoperative blood loss(50.39±30.19 ml). During the 6-month follow-up, the creatinine value of the renal function in the non-occlusion group (78.47±10.98μmol/L) was lower than that in the occlusion group(98.21±8.06μmol/L).Conclusion: Zero-ischemia sutureless LPN technique can effectively reduce the time of ischemia and avoid renal ischemia-reperfusion injury. This surgical technique may be a feasible surgical method for the treatment of low RNS renal cell carcinoma.

Download Full-text