1
|
Li F, Zhou J, Chen S, Ji Z, Xie Y, Zeng R, Chen Y, Zheng Y. Blood Pressure Control and Renal Function Preservation of ex vivo Renal Artery Repair with Orthotopic Renal Autotransplantation for Complex Renal Artery Diseases. J Vasc Surg 2022; 76:1588-1595.e1. [DOI: 10.1016/j.jvs.2022.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/31/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
|
2
|
Zhu A, Connolly P, Hakimi AA. Endovascular management of a large renal artery aneurysm: a case report and review of the literature. BMC Urol 2021; 21:121. [PMID: 34493233 PMCID: PMC8425141 DOI: 10.1186/s12894-021-00877-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background A renal artery aneurysm is a rare clinical presentation that can be found incidentally on imaging or during workup for refractory hypertension. Its presentation can be similar to that of a renal artery pseudoaneurysm, but the etiologies of the two vascular lesions differ. We present a patient who had an incidental finding of a large renal artery aneurysm that was managed with endovascular embolization. We also describe the literature surrounding the etiology, presentation and management of both renal artery aneurysms and renal artery pseudoaneurysms. Case presentation A 62-year-old man was referred to a urologic oncologist for workup of a newly found renal mass. Initial imaging with computed tomography showed a homogenous, well-circumscribed mass arising from the right kidney. Further evaluation with Doppler ultrasonography demonstrated pulsatile flow within the renal mass that was concerning for a renal artery pseudoaneurysm. The patient initially underwent a diagnostic angiogram by interventional radiology and was found to have a true renal artery aneurysm. Interventional radiology considered placement of a covered stent or angioembolization, but treatment was deferred due to concern for compromising the patient’s renal function. Patient was subsequently transferred to a neighboring hospital for management by vascular surgery. After considering both open surgical and endovascular approaches, the patient ultimately underwent angioembolization of the renal artery aneurysm. Short-term follow-up showed successful exclusion of the aneurysm with minimal adverse effects to the patient. Conclusions Our case report documents a unique case of an incidentally found large renal artery aneurysm that was successfully managed with endovascular embolization. Renal artery aneurysms and renal artery pseudoaneurysms, which can present similarly on imaging, are important diagnostic considerations in a patient presenting with a new renal mass. While open surgical approaches can be used to repair aneurysms, endovascular approaches using stenting or angioembolization are safe and effective options for treating renal aneurysms and renal pseudoaneurysms.
Collapse
Affiliation(s)
- Alec Zhu
- NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA.
| | - Peter Connolly
- NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| |
Collapse
|
3
|
|
4
|
Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
|
5
|
Irsara S, Russo F, Ferretto L. In Situ Treatment of Branch Renal Artery Aneurysms With Pantaloon Vein Graft. Vasc Endovascular Surg 2019; 54:272-277. [DOI: 10.1177/1538574419895372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The optimal method of operative management of complex renal artery aneurysms (RAAs) involving distal branches (BRAAs) remains unclear. When more than 1 artery is involved within the BRAA, endovascular techniques are not advisable and an ex vivo approach is often preferred. In this study, we introduce an alternative surgical in situ technique to treat BRAAs. Methods and Surgical Technique: Five aneurysms involving the main or second-order bifurcation of the renal artery (RA) were treated in 4 patients at our institute between November 2012 and January 2017. The treatment of the BRAAs was based on resection of the aneurysm wall and reconstruction with autologous Pantaloon vein graft (PVG): a “Y-shaped” bypass created on-bench with autogenous great saphenous vein. Sequential clamping/reperfusion of the kidney allows to reduce renal function impairment. Results: No perioperative mortality or morbidity was observed, including none nephrectomy. In all the cases, aneurysms were treated with an in situ technique as previously planned. All the grafts were patent at the follow-up time (mean 64.1 ± 11.7 months). Renal function was preserved in all the cases. Vascularization of the renal parenchyma was satisfactory both on arterial echo Doppler and contrast-medium ultrasound in all the cases. Average cross-clamping times of the main RA and of a single branch RA were 15.8 ± 1.7 and 17.7 ± 4.6 minutes, respectively. Mean total operating time was 266.3 ± 18.9 minutes. Conclusion: The PVG with sequential clamping applied in the surgical treatment of BRAAs permits to reduce the ischemic effects to the renal parenchyma. To our knowledge, these are the first cases described in which BRAAs are treated with a PVG and our experience suggests that it is a feasible technique, with good long-term results and without severe adverse events recorded.
Collapse
Affiliation(s)
- Sandro Irsara
- Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, Castelfranco Veneto, ULSS 2, Veneto Region, Italy
| | - Francesco Russo
- Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, Castelfranco Veneto, ULSS 2, Veneto Region, Italy
| | - Luca Ferretto
- Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, Castelfranco Veneto, ULSS 2, Veneto Region, Italy
| |
Collapse
|
6
|
Li FD, Ji ZG, Liu CW, Shao J, Xie Y, Zheng YH. Orthotopic renal autotransplantation for young-onset and medical treatment-requiring complex renovascular hypertension. J Renin Angiotensin Aldosterone Syst 2018; 19:1470320318789861. [PMID: 30129810 PMCID: PMC6104217 DOI: 10.1177/1470320318789861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In this article, we aim to prove the safety and effectiveness of orthotopic renal autotransplantation using ex vivo repair for the treatment of complex renovascular hypertension (RVH). METHODS We retrospectively reviewed five consecutive patients (three women, two men) with young-onset RVH from January 2009 to August 2014. Orthotopic renal autotransplantation using ex vivo repair was performed and perioperative data were collected for statistical analysis. RESULTS The median age at diagnosis was 20 years (range, 11 to 27 years). Technique success was achieved in all the patients with no in-hospital or late deaths. During a median follow-up of 3.4 years (range, 1.5 to 6 years), the postoperative blood pressure was decreased compared with preoperative level (204 ± 8/133 ± 8 mm Hg vs 129 ± 3/78 ± 5 mm Hg; p < 0.0001). The postoperative anti-hypertensive medications number was reduced (3.4 ± 0.4 vs 0.2 ± 0.2; p < 0.0001). Early and late renal functions were both well preserved as measured by no changes in serum creatinine level ( p > 0.05). The primary patent rate was 100% (5/5) at one-year follow-up. CONCLUSION In our small series, orthotopic renal autotransplantation using ex vivo repair was safe and effective for the resolution of complex young-onset RVH.
Collapse
Affiliation(s)
- Fang-Da Li
- 1 Department of Vascular Surgery, Peking Union Medical Hospital, China
| | - Zhi-Gang Ji
- 2 Department of Urology Surgery, Peking Union Medical Hospital, China
| | - Chang-Wei Liu
- 1 Department of Vascular Surgery, Peking Union Medical Hospital, China
| | - Jiang Shao
- 1 Department of Vascular Surgery, Peking Union Medical Hospital, China
| | - Yi Xie
- 2 Department of Urology Surgery, Peking Union Medical Hospital, China
| | - Yue-Hong Zheng
- 1 Department of Vascular Surgery, Peking Union Medical Hospital, China
| |
Collapse
|
7
|
|
8
|
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory angiopathy of unknown cause affecting medium-sized (most commonly renal) arteries and causing renovascular hypertension. The most common medial multifocal type of FMD (with the “string of beads” appearance) is more than four times more prevalent in females than in males. FMD accounts for up to 10% of cases of renovascular hypertension. Compared with patients with atherosclerotic renal artery stenosis, patients with FMD are younger, have fewer risk factors for atherosclerosis, and a lower occurrence of atherosclerosis in other vessels. The etiology is multifactorial, including vessel wall ischemia and smoking, as well as hormonal and genetic factors. Intra-arterial digital subtraction angiography is still the gold standard for exclusion or confirmation of renal artery stenosis caused by FMD, at least in young patients, who more often have lesions in branches of the renal artery. For FMD patients with atherosclerosis and those who are older (>50–55 years), significant renal artery stenosis may be confirmed or excluded with ultrasonography. The FMD lesion is typically truncal or distal, whereas atherosclerotic lesions are more often proximal or ostial. Treatment options are medical, endovascular (percutaneous transluminal renal angioplasty [PTRA]), and surgical. Invasive treatment should be considered when hypertension cannot be controlled with antihypertensive drugs and in patients with impaired renal function or ischemic nephropathy. PTRA has become the treatment of choice and normally yields good results, especially in unifocal disease and young patients. Pressure gradients are normally completely abolished, and there is no indication for stent placement. Surgical revascularization is indicated after PTRA complications; thrombosis, perforation, progressive dissection, repeated PTRA failure or restenosis. Centralization of handling is recommended.
Collapse
Affiliation(s)
- Anders Gottsäter
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Bengt Lindblad
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
9
|
Ham SW, Weaver FA. Ex vivo renal artery reconstruction for complex renal artery disease. J Vasc Surg 2014; 60:143-50. [DOI: 10.1016/j.jvs.2014.01.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
|
10
|
Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048-78. [PMID: 24548843 DOI: 10.1161/01.cir.0000442577.96802.8c] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
11
|
Robinson WP, Bafford R, Belkin M, Menard MT. Favorable outcomes with in situ techniques for surgical repair of complex renal artery aneurysms. J Vasc Surg 2011; 53:684-91. [DOI: 10.1016/j.jvs.2010.10.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 09/24/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
|
12
|
Cura M, Elmerhi F, Bugnogne A, Palacios R, Suri R, Dalsaso T. Renal aneurysms and pseudoaneurysms. Clin Imaging 2011; 35:29-41. [DOI: 10.1016/j.clinimag.2009.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/03/2009] [Indexed: 01/16/2023]
|
13
|
Giulianotti PC, Bianco FM, Addeo P, Lombardi A, Coratti A, Sbrana F. Robot-assisted laparoscopic repair of renal artery aneurysms. J Vasc Surg 2010; 51:842-9. [DOI: 10.1016/j.jvs.2009.10.104] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/02/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
|
14
|
Pratap T, Sloand JA, Narins CR. Potential Pitfalls of Renal Angiography: A Case of Atypical Fibromuscular Dysplasia. Angiology 2008; 59:753-6. [DOI: 10.1177/0003319707308726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although angiography remains the gold standard for the diagnosis of renal artery stenosis, renovascular disease can at times present with unusual patterns that may be difficult to detect. The authors present a case in which an initial renal angiogram failed to identify the presence of severe disease involving both a main and accessory renal artery. Repeat angiography coupled with the use of adjunctive catheter-based techniques including translesional pressure gradient determination and intravascular ultrasound with virtual histology imaging revealed the presence of atypical fibromuscular dysplasia that was treated with good clinical results. The case highlights the importance of performing careful and complete renal angiography, including imaging of smaller accessory renal arteries, and describes several readily available catheter-based techniques that can be useful in elucidating the physiological significance and etiology of renal artery stenosis.
Collapse
Affiliation(s)
- T. Pratap
- Division of Cardiology, the University of Rochester School of Medicine, Rochester, New York
| | - James A. Sloand
- Division of Nephrology, the University of Rochester School of Medicine, Rochester, New York
| | - Craig R. Narins
- Division of Cardiology, the University of Rochester School of Medicine, Rochester, New York, Division of Vascular Surgery, the University of Rochester School of Medicine, Rochester, New York,
| |
Collapse
|
15
|
Carmo M, Bower TC, Mozes G, Nachreiner RD, Textor SC, Hoskin TL, Kalra M, Noel AA, Panneton JM, Sullivan TM, Gloviczki P. Surgical Management of Renal Fibromuscular Dysplasia: Challenges in the Endovascular Era. Ann Vasc Surg 2005; 19:208-17. [PMID: 15735948 DOI: 10.1007/s10016-004-0164-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Percutaneous transluminal renal angioplasty (PTRA) is the primary treatment for renal fibromuscular dysplasia (RFMD). Surgical revascularization is limited to patients who fail or are unsuitable for PTRA. All patients who were operated on with RFMD since the indications for renal PTRA were expanded in our institution were retrospectively reviewed. Outcome included patency, hypertension, and renal function. Twenty-six patients had reconstruction of 32 renal arteries between 1998 and 2004. The mean age was 47.1 +/- 14 years; the majority (81%) were female. Six patients had bilateral disease and three had a solitary kidney. Operations were done for hypertension in 25 patients, renal artery aneurysm in 8, and chronic dissection in 1, alone or in combination. Six patients had a failed PTRA and 20 were unsuitable for it. Aortorenal bypass was done most often (n = 28) and saphenous vein was the preferred conduit (n = 25). The distal anastomosis was to the main renal artery in 13 patients and to the branch arteries in 19. Ex vivo repair was needed in five patients. Five intraoperative revisions were done because of abnormalities on duplex scan. One patient died unexpectedly 42 days after operation from myocardial infarction. Extrarenal complications occurred in five patients. Median follow-up was 2.4 (range, 42 days to 6.3) years and was available in all but one patient (96%). Two bypasses occluded at 3 and 376 days, which resulted in loss of the kidneys. One graft stenosis was treated successfully with PTRA at 239 days. All failures occurred in men. One-year cumulative primary patency was 89 +/- 8% and was not adversely affected by prior PTRA or complex repair. Hypertension at 1 year was cured in 27% of the patients and improved in 60%. No patient developed acute or chronic renal failure. Surgical reconstruction for RFMD has excellent short-term patency. Failed PTRA or complex reconstructions did not adversely affect outcome.
Collapse
Affiliation(s)
- Michele Carmo
- Division of Vascular Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
English WP, Pearce JD, Craven TE, Wilson DB, Edwards MS, Ayerdi J, Geary RL, Dean RH, Hansen KJ. Surgical management of renal artery aneurysms. J Vasc Surg 2004; 40:53-60. [PMID: 15218462 DOI: 10.1016/j.jvs.2004.03.024] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This retrospective review describes the surgical management and clinical outcome for renal artery aneurysms (RAAs) in 62 consecutive patients. METHODS From January 1987 through July 2003, 804 patients had operative renal artery (RA) repair involving 1206 kidneys at our center. A subgroup of 62 patients (42 women, 20 men; mean age 46 +/- 18 years) received repair of 72 RAAs. Demographic data, comorbidity, and surgical technique were examined. Blood pressure and renal function response were determined. Patency of repair was evaluated by renal duplex sonography. Primary patency and patient survival were estimated by life-table methods. Tests of association were performed using chi(2) and the Student t tests. RESULTS Seventy-two RAs were repaired for RAA with a mean diameter of 2.6 cm (range, 1.3 to 5.5 cm). Bilateral RAAs were present in 21 patients. Associated conditions included fibromuscular dysplasia, atherosclerosis, and arteritis in 54%, 35%, and 7%, respectively. Hypertension was present in 89% (mean blood pressure, 171 +/- 35/95 +/- 19 mm Hg; mean medications, 2.2 +/- 1.2 drugs) and renal insufficiency was present in 8% (mean serum creatinine, 1.9 +/- 0.6 mg/dL). RAA repair included bypass (67%), aneurysmorrhaphy (15%), or a combination (17%). One planned nephrectomy (1%) was performed for un-reconstructable disease. Branch RA reconstruction in 78% used ex vivo cold perfusion in 50%, in situ cold perfusion in 29%, and warm in situ repair in 21%. Of 9 bilateral RAA repairs, 7 (78%) were staged and 2 (22%) were simultaneous. Combined aortic reconstruction was required in 6 (10%) patients. Perioperative death occurred in 1 patient (1.6%), and significant morbidity was observed in 8 patients (12%). Hypertension was considered improved in 54%, cured in 21%, and unchanged in 25% at mean follow-up of 48 months (range, 1-156 months). Among patients with renal insufficiency, renal function was improved in 3 (60%), unchanged in 1 (20%), and declined in 1 (20%). Follow-up patency (mean, 33 months; range, 1-118 months) was determined for 64 (91%) RA reconstructions. Product-limit estimate of primary patency at 48 months was 96%. Product-limit estimate of survival was 91% at 120 months. CONCLUSION RAAs were repaired with low morbidity and mortality. Complex branch RAA repair using cold perfusion preservation and ex vivo techniques resulted in no unplanned nephrectomy, with an estimated primary patency of 96% at 48 months. Beneficial blood pressure response was observed in the majority of hypertensive patients. These results support selective surgical management of RAA.
Collapse
Affiliation(s)
- William P English
- Division of Surgical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Boggi U, Ferrari M, Vistoli F, Sgambelluri F, Vignali C, Cioni R, Petruzzi P, Del Chiaro M, Berchiolli R, Signori S, Coletti L, Gremmo F, Rizzo G, Mosca F. Rescue of kidney and pancreas grafts with complex vascular lesions. Transplant Proc 2004; 36:505-8. [PMID: 15110573 DOI: 10.1016/j.transproceed.2004.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The organ shortage mandates that grafts with complex vascular lesions be considered for graft rescue. METHODS Surgical graft rescue was attempted in 8 patients bearing 8 kidneys and 2 pancreata that showed complex vascular lesions deemed not suitable for interventional radiology procedures. RESULTS All procedures but 1 were performed under elective conditions. Seven grafts were repaired in situ, while cooling the organ through retrograde venous perfusion, and 3 kidneys were explanted, repaired extracorporeally, and retransplanted. All vascular reconstructions remain patent after a mean follow-up period of 3.3 years (+/-2.1 years). CONCLUSIONS Careful patient selection, multidisciplinary evaluation, and personalized surgical technique may allow the rescue of kidney and pancreas grafts with complex vascular lesions that, otherwise, would be lost.
Collapse
Affiliation(s)
- U Boggi
- Divisione di Chirurgia Generale e Trapianti Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Angelis M, Augenstein JS, Ciancio G, Figueiro J, Sfakianakis GN, Miller J, Burke GW, Wessells H. Ex vivo repair and renal autotransplantation after penetrating trauma: is there an upper limit of ischemic/traumatic injury beyond which a kidney is unsalvageable? THE JOURNAL OF TRAUMA 2003; 54:606-9; discussion 609. [PMID: 12634546 DOI: 10.1097/01.ta.0000047051.46977.6f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Angelis
- Department of Surgery, Division of Transpalntation, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Ysa-Figueras A, Clará A, de la Fuente-Sánchez N, Roig-Santamaría L, Miralles M, Santiso-Fernández A, Martínez-Cercos R, Vidal-Barraquer Mayol F. Cirugía ex vivo y autotrasplante en el tratamiento de aneurismas de arteria renal. ANGIOLOGIA 2003. [DOI: 10.1016/s0003-3170(03)74808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Bisschops RH, Popma JJ, Meyerovitz MF. Treatment of fibromuscular dysplasia and renal artery aneurysm with use of a stent-graft. J Vasc Interv Radiol 2001; 12:757-60. [PMID: 11389229 DOI: 10.1016/s1051-0443(07)61449-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A Jostent stent-graft was placed in a renal artery with a focal stenosis and an associated aneurysm in a young patient with fibromuscular dysplasia. Arteriographic follow-up at 16 months showed that the stent-graft remained patent and the aneurysm was excluded.
Collapse
Affiliation(s)
- R H Bisschops
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|
21
|
Cho CS, Robinson PW, Grant AB, Hibberd AD. Successful ex vivo renal artery reconstruction and renal autotransplantation. ANZ J Surg 2001; 71:79-82. [PMID: 11413597 DOI: 10.1046/j.1440-1622.2001.02043.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery. METHODS A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital. RESULTS Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years. CONCLUSION The present review confirms the long-term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.
Collapse
Affiliation(s)
- C S Cho
- Department of General Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | | | | |
Collapse
|
22
|
Reiher L, Pfeiffer T, Sandmann W. Long-term results after surgical reconstruction for renal artery fibromuscular dysplasia. Eur J Vasc Endovasc Surg 2000; 20:556-9. [PMID: 11136592 DOI: 10.1053/ejvs.2000.1201] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To study the initial and long-term results of surgery for renal artery fibromuscular dysplasia (RFMD). PATIENTS AND METHODS All patients undergoing renal artery reconstruction (RAR) performed for RFMD between January 1980 and December 1997, were studied. The preprocedural and postprocedural clinical records of 101 patients (80 women, 21 men; mean age at surgery 43 years) were retrospectively reviewed. All surviving patients were invited for clinical reexamination and colour-coded duplex-ultrasound of the renal arteries (RA). RESULTS Initial technical success was achieved in 83 of 93 patients (89%), in whom postoperative angiography (90) or renal scintigraphy (three) were performed for assessment of RAR. Early occlusion (four) or stenosis (one) demanded reoperation in five patients (5%). The 30-day mortality and morbidity were 2% and 12% for the entire group. Primary patency rate was 74% at 5 years. Fifteen patients had to be reoperated for restenosis after a mean time of 33 months, resulting in a secondary patency rate of 85% after 5 years. In 61 patients with patent RAR at the time of re-examination, arterial hypertension was cured only in 22 (36%) and improvement in 19 (31%). CONCLUSION Vascular surgery for RFMD yields good long-term results as to kidney perfusion and function. Surveillance of RAR-patency by means of ultrasound examination is mandatory in case of recurrence of arterial hypertension or deterioration. Rates of cure of hypertension are disappointing.
Collapse
Affiliation(s)
- L Reiher
- Department for Vascular Surgery and Kidney Transplantation, Heinrich Heine University, Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | | | | |
Collapse
|
23
|
Abstract
Vascular reconstructive surgery in urology includes techniques of revascularization of the renal artery for renovascular hypertension or ischemic nephropathy in situ or extracorporeal renal artery reconstruction. The indications for aortorenal bypass, extra-anatomic bypass, or simultaneous aortic substitution and renal revascularization are based on the cause, location, and extent of the vascular lesion. Techniques of bench surgery mainly depend on location of the renal artery disease and availability of autologous graft material.
Collapse
Affiliation(s)
- A Sorcini
- Department of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | | |
Collapse
|
24
|
|
25
|
Seki T, Koyanagi T, Togashi M, Chikaraishi T, Tanda K, Kanagawa K. Experience with revascularizing renal artery aneurysms: is it feasible, safe and worth attempting? J Urol 1997; 158:357-62. [PMID: 9224303 DOI: 10.1016/s0022-5347(01)64479-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We retrospectively evaluated the feasibility and efficacy of surgical revascularization for renal artery aneurysms. MATERIALS AND METHODS Beginning in 1984, 12 patients with renal artery aneurysm underwent renal revascularization regardless of clinical features. Postoperative results were analyzed regarding split renal function, patency of the revascularized arteries, blood pressure control and surgical complications. RESULTS Postoperative renal function was stable or improved in all but 1 case and patency in branched arteries was preserved in 86%. Hypertension in 8 patients was cured in 7 (88%), including 2 with renovascular hypertension, and improved in 1 (12%). Complications were minimal with only 1 ureteral stricture that required reoperation. CONCLUSIONS The majority of renal artery aneurysm cases are amenable to surgical repair. Carefully performed renal revascularization is rewarding in that high blood pressure is better controlled, renal function is improved and the potential risk of rupture is obviated.
Collapse
Affiliation(s)
- T Seki
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
| | | | | | | | | | | |
Collapse
|
26
|
Affiliation(s)
- G A Sicard
- Section of Vascular Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | |
Collapse
|
27
|
Kuestner LM, Stoney RJ. The case for renal revascularization. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1995; 3:141-54. [PMID: 7606398 DOI: 10.1016/0967-2109(95)90886-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This report reviews renovascular disease, hypertension and renal parenchymal dysfunction. The primary lesions responsible are discussed as well as the strategies for restoring normal renal perfusion. The natural history studies document progressive impairment of renal perfusion and the consequence of renal dysfunction. Renal revascularization interrupts this pathway by relieving or lessening hypertension and preserving renal function which are the therapeutic options.
Collapse
Affiliation(s)
- L M Kuestner
- Department of Surgery, University of California, San Francisco 94143, USA
| | | |
Collapse
|