scholarly journals Renal Artery Pseudo-aneurysms: Do All of Them Require Endovascular Management?

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naseer Choh ◽  
Mudasir Bhat ◽  
Omair Shah ◽  
Imran Hafeez ◽  
Faiz Shera ◽  
...  
Keyword(s):  
Renal Artery ◽  
Doppler Ultrasonography ◽  
Clinical Success ◽  
Significant Loss ◽  
Spontaneous Resolution ◽  
Limiting Factor ◽  
Imaging Features ◽  
Renal Angiography ◽  
Doppler Study ◽  
Peak Enhancement

Purpose: Our study examines the etiological profile, clinical and imaging features of renal artery pseudo aneurysms (RAPs), as well as the efficacy and need for the angioembolization of RAPs in a resource-constrained setting. Materials and Methods: A total of 36 patients with RAPs were included in our study. Initial diagnosis was made by Doppler Ultrasonography (USG) followed by CT renal angiography in all cases. DSA was performed in 28 patients, as eight patients showed spontaneous resolution by thrombosis on immediate pre-procedure Doppler study. Angioembolization with a microcoil was performed for 30 aneurysms in 28 patients. Technical success was confirmed at the end of the procedure by a renal angiogram. To assess clinical success, we followed up with patients (with clinical and Doppler USG) for a period of six months. Results: The most common cause of RAPs in our study was percutaneous nephrolithotomy (PCNL), seen in 21 patients (58.3%), followed by trauma (25%), and partial nephrectomy (11%). All patients presented to us were within 21 days of the etiological event of hematuria or flank pain. USG was able to detect the RAP in 22 cases (61%). CT renal angiography was diagnostic in all patients but failed to demonstrate two additional aneurysms in one patient. RAP size ≤ 4 mm and absence of brisk filling on CT renal angiography was associated with spontaneous resolution in eight patients, probably an indication of the beginning of spontaneous thrombosis. Angioembolization was done using microcoils and showed 100% technical and clinical success. Conclusion: PCNL is the most common etiological factor for RAPs in our setting. Such patients should have a Doppler USG done prior to discharge from the hospital. CT angiographic flow dynamics (delayed peak enhancement) may be helpful in the identification of RAPs with a high probability of subsequent spontaneous resolution. Angiography followed by embolization using microcoils is the most effective and safe treatment for RAPs with no significant loss of renal parenchyma, although cost remains a limiting factor in our setting.

Predictors for Clinical Success at One Year following Renal Artery Stent Placement

2002 ◽  
Vol 9 (4) ◽  
pp. 495-502 ◽  
Author(s):  
Trude C. Gill-Leertouwer ◽  
Elma J. Gussenhoven ◽  
Johanna L. Bosch ◽  
Jaap Deinum ◽  
Hans van Overhagen ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Artery Stenosis ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

scholarly journals Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension

2018 ◽  
Vol 14 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Lucas Lauder ◽  
Sebastian Ewen ◽  
Abraham Rami Tzafriri ◽  
Elazer Reuven Edelman ◽  
Thomas Felix Lüscher ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Renal Artery ◽  
Renal Angiography

Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia

2007 ◽  
Vol 61 (3) ◽  
pp. 520-527 ◽  
Author(s):  
Rohan Sabharwal ◽  
Philip Vladica ◽  
Patrick Coleman
Keyword(s):  
Renal Artery ◽  
Fibromuscular Dysplasia ◽  
Spiral Ct ◽  
Renal Angiography

Endovascular interventions in management of renal artery aneurysm

2021 ◽  
pp. 20201151
Author(s):  
Sandipan Ghosh ◽  
Soumya Kanti Dutta
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Endovascular Therapy ◽  
Coil Embolization ◽  
Clinical Success ◽  
Artery Aneurysm ◽  
Renal Infarction ◽  
Renal Artery Aneurysm ◽  
Selective Embolization ◽  
Complex Anatomy

Renal artery aneurysm is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females and patients with multiple comorbidities. Traditionally, aneurysms located in the main renal artery had been successfully treated with endoprosthesis but technical limitations existed in more distal locations where patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization[SACE], balloon-assisted coil embolization[BACE], selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-Hystroacril and Onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization have been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.

scholarly journals Renal artery embolization for iatrogenic renal vascular injuries management: 5 years’ experience

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190256 ◽  
Author(s):  
Andrea Contegiacomo ◽  
Enrico Maria Amodeo ◽  
Alessandro Cina ◽  
Carmine Di stasi ◽  
Roberto Iezzi ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Renal Artery ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Vascular Injuries ◽  
Technical Success ◽  
Artery Embolization ◽  
Renal Artery Embolization ◽  
Embolic Materials ◽  
Renal Vascular

Objective: Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. Methods: Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. Results: 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI. The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028). Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016). No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). Conclusion: RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. Advances in knowledge: Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.

PO17-495 VALUE OF DOPPLER ULTRASONOGRAPHY IN RENAL ARTERY STENOSIS RECOGNITION

2007 ◽  
Vol 8 (1) ◽  
pp. 138-139
Author(s):  
A. Kablak-Ziembicka ◽  
T. Przewlocki ◽  
W. Tracz ◽  
G. Kopec ◽  
P. Pieniazek ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Doppler Ultrasonography ◽  
Artery Stenosis
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