Serial changes in vessel walls of renal arteries after catheter-based renal artery denervation: insights from volumetric computed tomography analysis

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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Extended Renal Artery Denervation Is Associated with Artery Wall Lesions and Acute Systemic and Pulmonary Hemodynamic Changes: A Sham-Controlled Experimental Study

Cardiovascular Therapeutics ◽

10.1155/2020/8859663 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Aleksandr D. Vakhrushev ◽

Heber Ivan Condori Leandro ◽

Natalia S. Goncharova ◽

Lev E. Korobchenko ◽

Lubov B. Mitrofanova ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Systolic Blood Pressure ◽

Renal Arteries ◽

Artery Wall ◽

Pulmonary Hemodynamics ◽

Pulmonary Hemodynamic ◽

Renal Artery Denervation ◽

The Impact ◽

Wall Lesions

Objectives. We sought to assess acute changes in systemic and pulmonary hemodynamics and microscopic artery lesions following extended renal artery denervation (RDN). Background. RDN has been proposed to reduce sympathetic nervous system hyperactivation. Although the effects of RDN on systemic circulation and overall sympathetic activity have been studied, data on the impact of RDN on pulmonary hemodynamics is lacking. Methods. The study comprised 13 normotensive Landrace pigs. After randomization, 7 animals were allocated to the group of bilateral RDN and 6 animals to the group of a sham procedure (SHAM). Hemodynamic measures, cannulation, and balloon-based occlusion of the renal arteries were performed in both groups. In the RDN group, radiofrequency ablation was performed in all available arteries and their segments. An autopsy study of the renal arteries was carried out in both groups. Results. The analysis was performed on 12 pigs (6 in either group) since pulmonary thromboembolism occurred in one case. A statistically significant drop in the mean diastolic pulmonary artery pressure (PAP) was detected in the RDN group when compared with the SHAM group (change by 13.0 ± 4.4 and 10.0 ± 3.0 mmHg , correspondingly; P = 0.04 ). In 5 out of 6 pigs in the RDN group, a significant decrease in systemic systolic blood pressure was found, when compared with baseline ( 98.8 ± 17.8 vs. 90.2 ± 12.6 mmHg , P = 0.04 ), and a lower mean pulmonary vascular resistance (PVR) ( 291.0 ± 77.4 vs. 228.5 ± 63.8 dyn ∗ sec ∗ c m − 5 , P = 0.03 ) after ablation was found. Artery dissections were found in both groups, with prevalence in animals after RDN. Conclusions. Extensive RDN leads to a rapid and significant decrease in PAP. In the majority of cases, RDN is associated with an acute lowering of systolic blood pressure and PVR. Extended RDN is associated with artery wall lesions and thrombus formation underdiagnosed by angiography.

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PP-331 Renal Artery Denervation with Accessory Renal Arteries

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.01.361 ◽

2014 ◽

Vol 113 (7) ◽

pp. S140

Author(s):

A. Hallak ◽

O. Hallak ◽

M. Tattan ◽

O. Hallak

Keyword(s):

Renal Artery ◽

Renal Arteries ◽

Renal Artery Denervation ◽

Accessory Renal Arteries

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Computed Tomography Angiography-Based Evaluation of Anatomical Variations of the Celiac ‎Trunk and Renal Arteries

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i3.27797 ◽

2020 ◽

Vol 10 (3) ◽

pp. 27797

Author(s):

Sara Besharat ◽

Parima Safe ◽

Husain Karrabi ◽

Nasser Malekpour Alamdari

Keyword(s):

Computed Tomography ◽

Renal Artery ◽

Computed Tomography Angiography ◽

Celiac Trunk ◽

Anatomical Variations ◽

Left Gastric Artery ◽

Renal Arteries ◽

Gastric Artery ◽

Accessory Renal Artery ◽

Prevalent Form

Background: The abdominal aorta and its main branches, such as the celiac trunk and the renal arteries are manipulated during various radiologic, surgical, and oncologic procedures. This study aimed at evaluating the anatomical pattern of these vessels to assist surgeons and radiologists reduce the risk of intra- as well as postoperative complications. Methods: A retrospective analysis of 536 Computed Tomography Angiography (CTA) studies of living potential kidney donors was conducted from January 2012 to December 2018. Results: The anatomical variations of the celiac trunk was found in 9.5% of the cases. Among these cases, the most frequent variation was the Left Gastric Artery (LGA) as the first branch of the celiac trunk (80.4% of the cases). Gender was not overall significantly associated with the variations of the celiac trunk (P=0.670); however, there was a significant correlation between male gender and the most prevalent form of the celiac trunk variation (P=0.004). Variations of the renal artery occurred in 22.94% of the cases, with the left accessory renal artery being the most common variant (28.45% of the cases). Gender and the involved side (right/left) were not significantly related to the renal artery variations (P=1.000 & P=0.546, respectively). No concomitant variation of the celiac trunk and the renal artery was detected in our study. Conclusion: The anatomical variations of the celiac trunk and the renal arteries occur commonly; thus, the branching pattern of these arteries should be assessed prior to any procedure concerning them.

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Complex Arteriovenous Malformation in a Kidney with Multiple Renal Arteries: A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/46590.14328 ◽

2020 ◽

Author(s):

J Sanjay Prakash ◽

T Mathisekaran ◽

Nitesh Jain ◽

Pritam Chatterjee ◽

Sandeep Bafna

Keyword(s):

Computed Tomography ◽

Arteriovenous Malformation ◽

Renal Artery ◽

Renal Vein ◽

Renal Arteries ◽

Contrast Enhanced ◽

Complete Obliteration ◽

Ct Brain ◽

Enhanced Computed Tomography

The abnormal communications between arteries and veins outside the capillary level are called Arteriovenous Malformation (AVM). A 25-year-old known hypertensive on irregular medications, presented with acute stroke (Computed Tomography (CT) brain revealed left putamen haemorrhage). On evaluation, all routine investigations were normal except for microscopic haematuria. Ultrasound (USG) KUB showed right AVM and on further evaluation with 320 slice Contrast Enhanced Computed Tomography (CECT) abdomen with angiogram and 3D reconstruction revealed right kidney supplied by three renal arteries. The second renal artery was dilated (1.1 cm diameter) and communicates directly with aneurysmally dilated right renal vein (2.9 cm diameter). Digital Subtraction Angiography (DSA) with angioembolisation was done four days’ postadmission. Large second renal artery with a direct Arteriovenous Fistula (AVF) draining into the renal vein with aneurysmal venous sacs was occluded with 16 mm, 12 mm and 10 mm coils. Complete obliteration of fistula was confirmed. Then the inferior most third renal artery was accessed and angiogram revealed RAVM with multiple feeders shunting into the venous sacs and it was occluded with 40% glue. Postoperative day one USG showed thrombosed venous aneurysmal sacs and occlusion of the arterial fistulae. He was discharged at four weeks with antihypertensive and antiseizure medications. During the follow-up there was no loss in the function of the kidney and micro or macroscopic haematuria was not detected.

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Bilateral Supernumerary Renal Arteries with variant Ureteric Relation and their Embryological and Clinical Significance

National Journal of Clinical Anatomy ◽

10.1055/s-0039-1700729 ◽

2017 ◽

Vol 06 (01) ◽

pp. 082-089

Author(s):

Vidya Gunasekaran ◽

Gladwin Victor Raj ◽

Aravindhan Kishore ◽

Parkash Chand

Keyword(s):

Renal Artery ◽

Renal Arteries ◽

Successful Outcome ◽

Undergraduate Medical Students ◽

Renal Vasculature ◽

Surgical Interventions ◽

Field Of Vision ◽

Male Cadaver ◽

Renal Artery Denervation ◽

The Right

AbstractVariations in the renal vasculature always deserve a special attention owing to its higher prevalence and wider range. A thorough knowledge of the normal morphology and the variations in the origin, course, branches and distribution of the renal vasculature are essential for the successful outcome of the surgical interventions in this region without dreadful complications. During routine dissection for the undergraduate medical students following the standard procedures, dissection of the retroperitoneal region in a male cadaver, revealed bilateral variations in the number, origin, course and branches of the renal arteries.The renal arteries with its branches were dissected out meticulously and the variations encountered were documented. Bilateral supernumerary renal arteries with extra-hilar and pre-hilar branches were observed. In addition, it was found that the supernumerary inferior pre- caval right renal artery had a variant course in relation to ureter before entering the hilum of the right kidney. The variant renal arteries documented in the present study with their embryological correlation is clinically important in the urological management, especially during the laparoscopic donor nephrectomy, where the field of vision is limited and also in the endovascular renal artery denervation procedure, which is an useful adjuvant for the patients having drug-resistant primary hypertension.

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