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Mouhanni S, Lahlou S, Bakkali T, Bounssir A, Lekehal B. Successful coiling embolization of an intraparenchymal renal pseudoaneurysm: Case reports. Int J Surg Case Rep 2024; 116:109275. [PMID: 38428053 PMCID: PMC10943654 DOI: 10.1016/j.ijscr.2024.109275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intraparenchymal renal artery aneurysms are a really rare condition that represents <10 % of all renal artery aneurysms. They are more often caused by trauma or iatrogenic injury and their rupture can lead to life-threatening hemorrhage. CASE PRESENTATION We report the case of a 25-year-old male with history of back stab wound three months before being admitted to our unity. The patient presented a macroscopic hematuria three days after the injury. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with super selective endovascular coil embolization, achieving both pseudoaneurysm exclusion and renal preservation. CLINICAL DISCUSSION Intraparenchymal renal artery aneurysms are rare. They are more often caused by trauma or iatrogenic injury. Renal artery pseudoaneurysms are mainly asymptomatic. Renal pseudoaneurysms can be diagnosed through contrast enhanced CT, renal Doppler ultrasound, or MRI. Super selective embolization of the feeding artery of the pseudoaneurysm using endovascular techniques is the treatment of choice. CONCLUSION The management of patients with renal pseudo aneurysms should allow to achieve two main goals: Preserving Renal function, and excluding the pseudoaneurysm.
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Affiliation(s)
- Safaa Mouhanni
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco.
| | - Salim Lahlou
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Tarik Bakkali
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Ayoub Bounssir
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Brahim Lekehal
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
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Oluborode B, Kerby E, Park H, Malinzak L. Surveillance of a Transplant Kidney Harboring a Stable Renal Artery Aneurysm: A Case Report. Transplant Proc 2024; 56:257-259. [PMID: 38195286 DOI: 10.1016/j.transproceed.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 01/11/2024]
Abstract
Renal artery aneurysms (RAAs) may occur in patients with transplanted kidneys, either through de novo development or as a preexisting feature of the donor kidney. How this vascular condition progresses in patients on immunosuppressive therapy after transplantation is poorly understood, and to our knowledge, consensus guidelines for treating transplant patients with RAA have not been developed. We present the case of a kidney allograft recipient on triple immunosuppressive therapy in whom postoperative imaging revealed a 13-mm renal artery aneurysm in the renal hilum not amenable to endovascular intervention. We review systemic influences on aneurysm formation and how matrix metalloproteinases may interact with immunosuppressive medications. Surveillance imaging over 5 years has shown a stable aneurysm, and the patient has maintained stable renal function with adequate creatinine levels and no adverse symptoms.
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Affiliation(s)
| | - Emily Kerby
- Division of Transplant Surgery, Department of Surgery, Henry Ford Hospital System, Detroit, Michigan
| | - Hakmin Park
- Division of Abdominal Imaging, Department of Radiology, Henry Ford Hospital System, Detroit, Michigan
| | - Lauren Malinzak
- Division of Transplant Surgery, Department of Surgery, Henry Ford Hospital System, Detroit, Michigan.
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3
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Liao H, Yang Y, Zhang W, Zhang S, Dai H, Chen F. Renal artery pseudoaneurysm formation and rupture induced by renal abscess: A case report. Urol Case Rep 2023; 51:102547. [PMID: 37701418 PMCID: PMC10493886 DOI: 10.1016/j.eucr.2023.102547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
Severe consequences can ensue from the rupture and hemorrhage of a renal artery pseudoaneurysm, necessitating immediate intervention upon detection. To date, no reports exist on the development of renal artery pseudoaneurysms as a result of renal abscesses. This document introduces the first reported case of this occurrence.
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Affiliation(s)
- Hai Liao
- Department of Urology, The First People's Hospital of Suining, Suining, 629000, China
| | - Yong Yang
- Department of Urology, The First People's Hospital of Suining, Suining, 629000, China
| | - Wensen Zhang
- Department of Urology, The First People's Hospital of Suining, Suining, 629000, China
| | - Senlin Zhang
- Department of Urology, The First People's Hospital of Suining, Suining, 629000, China
| | - Hang Dai
- Department of Urology, The First People's Hospital of Suining, Suining, 629000, China
| | - Fubing Chen
- Department of Urology, The First People's Hospital of Suining, Suining, 629000, China
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Ho CERH, So WZ, Wong J, Tiong HY. Successful repair of transplant renal artery aneurysm (TRAA). BMC Urol 2023; 23:129. [PMID: 37525164 PMCID: PMC10391898 DOI: 10.1186/s12894-023-01280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Transplant renal artery aneurysm (TRAA) is rare. TRAA that develops post transplantation consists of 0.10% of the vascular complications post renal transplant (Transplant Proc 41:1609-1614, 2009; Indian J Urol 29:42-47, 2013). CASE PRESENTATION We report a case of TRAA in an asymptomatic young female. CT angiogram with detailed 3D reconstruction showed a 2.6 × 2.2 cm wide neck saccular TRAA arising from the anterior segmental branch of the graft renal artery (Figs. 2 and 3). A multidisciplinary team of interventional radiologists, vascular and urologist was involved for preoperative surgical planning and unique repair methods. Endovascular and percutaneous approaches were deemed not feasible, and an open in vivo approach with a saphenous vein graft was taken. CONCLUSION TRAA, albeit rare, is a complication that can occur post renal transplant. In-vivo surgical repair of TRAA is feasible with a multidisciplinary approach and careful preoperative planning. Saphenous vein graft is still a versatile graft and can be used as a conduit successfully.
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Affiliation(s)
| | - Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Julian Wong
- National University Hospital, Singapore, Singapore
| | - Ho Yee Tiong
- National University Hospital, Singapore, Singapore.
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5
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Mousavi A, McWilliams JP, Danovitch GM, Nassiri N. An Unusual Cause of Abdominal Bruit. Urology 2023; 177:e3-e5. [PMID: 37076018 DOI: 10.1016/j.urology.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/11/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Ava Mousavi
- Department of Urology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Justin P McWilliams
- Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Gabriel M Danovitch
- Division of Transplant Nephrology, Department of Medicine, UCLA Kidney and Pancreas Transplantation Program, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Nima Nassiri
- Department of Urology, UCLA Kidney and Pancreas Transplantation Program, UCLA David Geffen School of Medicine, Los Angeles, CA.
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6
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Chandak P, Kessaris N, Karunanithy N, Byrne N, Newton J, Bharadwaj R, Assia-Zamora S, Shenoy M, Sallam M, Sinha MD. Utilizing 3D printing to facilitate surgical in-situ paediatric renal artery aneurysm repair for refractory hypertension. J Hypertens 2023; 41:194-197. [PMID: 36129111 DOI: 10.1097/hjh.0000000000003296] [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: 02/01/2023]
Abstract
Renal artery aneurysmal (RAA) disease is a rare, but potentially life-threatening cause of renovascular disease presenting with hypertension. Conventional management involves aneurysmal excision followed by renal auto-transplantation. We present the management of a 13-year-old girl with complex multiple saccular aneurysmal disease of the left renal artery with hilar extension and symptomatic hypertension. We used 3D printing to print a patient-specific model that was not implanted in the patient but was used for surgical planning and discussion with the patient and their family. Endovascular options were precluded due to anatomical complexities. Following multi-disciplinary review and patient-specific 3D printing, she underwent successful in-situ RAA repair with intraoperative cooling, without the need for auto-transplantation. 3D printing enabled appreciation of aneurysmal spatial configuration and dimensions that also helped plan the interposition graft length needed following aneurysmal excision. The models provided informed multidisciplinary communications and proved valuable during the consent process with the family for this high-risk procedure. To our knowledge, this is the first reported case utilizing 3D printing to facilitate in-situ complex repair of RAA with intra-hilar extension for paediatric renovascular disease.
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Affiliation(s)
- Pankaj Chandak
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Nicos Kessaris
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Narayan Karunanithy
- Department of Interventional Radiology, Evelina London Children's Hospital, Guy's and St Thomas' Hospitals NHS Trust
| | - Nick Byrne
- Department of Imaging Science and Biomedical Engineering, King's College London
| | - Joanna Newton
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust
| | - R Bharadwaj
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Sergio Assia-Zamora
- Department of Adult and Paediatric Transplantation, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust, Evelina London Children's Hospital and Faculty of Life Sciences and Medicine, King's College London
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Manchester University NHS Foundation Trust
| | - Morad Sallam
- Department of Vascular Surgery, Guy's and St Thomas' Hospitals NHS Trust
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas's NHS Foundation Hospitals NHS Trust
- Kings College London, London, UK
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7
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Lu T, Lin B, Zhang YP, Zhang JH, Luo JW, Tang Y, Fang ZT. Eighteen cases of renal aneurysms: Clinical retrospective analysis and experience of endovascular interventional treatment. Front Surg 2023; 10:1106682. [PMID: 36925508 PMCID: PMC10011095 DOI: 10.3389/fsurg.2023.1106682] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023] Open
Abstract
Background Development of endovascular interventional techniques gradually replaced traditional open surgery and has become the preferred treatment for renal aneurysms. This study aimed to analyze the clinical characteristics of renal artery aneurysm (RAA) and the safety and efficacy of intravascular interventional treatment. Materials and Methods We retrospectively analyzed the clinical characteristics and imaging data of 23 aneurysms in 18 patients with RAA. The technical success rate, complication rate, mortality rate, reintervention rate, and use of embolization materials were evaluated. Results In 18 patients with RAA (age, 32-72 years, average age, 52.2 ± 11.2 years), a total of 23 aneurysms were found (diameter 0.5-5.5 cm, average diameter 2.2 ± 1.4 cm). Among them, 11 cases (61.1%) were discovered accidentally, and the remaining patients were diagnosed due to the following major complaints: four cases (22.2%) presented low back pain, two (11.1%) were due to high blood pressure, and one (5.5%) had low back pain with gross hematuria. A total of 14 aneurysms in 13 patients received endovascular interventional therapy. The technical success rate of 13 patients with renal aneurysms was 100%. Three of the 18 patients were lost to follow-up, and the remaining were followed up for 4-89 months. There was no recurrence of the aneurysm or displacement of the stent or coil. Conclusion Endovascular treatment for RAA has a high success rate, low complication rate, and low reintervention rate. It has the advantage of less trauma and is flexible and more targeted for different types of renal aneurysms.
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Affiliation(s)
- Tao Lu
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Bin Lin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yan-Ping Zhang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jian-Hui Zhang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jie-Wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yi Tang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Zhu-Ting Fang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
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8
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Huynh AD, Sweet DE, Feldman MK, Remer EM. Imaging of renal emergencies: Review of infectious, hemorrhagic, vascular, and traumatic etiologies. Br J Radiol 2022; 95:20211151. [PMID: 35762317 PMCID: PMC10996964 DOI: 10.1259/bjr.20211151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/19/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
Diagnostic imaging allows for accurate and early recognition of acute renal pathologies, thus allowing for appropriate clinical triage, life-saving treatments, and preservation of renal function. In this review, we discuss the clinical presentation and imaging findings of renal emergencies with infectious, hemorrhagic, vascular, and traumatic etiologies.
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Affiliation(s)
- Alan D. Huynh
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - David E. Sweet
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - Myra K Feldman
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
| | - Erick M Remer
- Imaging Institute, Cleveland Clinic,
Cleveland, United States
- Glickman Urological and Kidney Institute, Cleveland
Clinic, Cleveland, United
States
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9
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Joseph A, Valakkada J, Ayappan A, Dandhaniya D. Endovascular interventions in main renal artery pathologies: an overview and update. Acta Radiol 2022; 63:964-975. [PMID: 34107749 DOI: 10.1177/02841851211019806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. This article provides a comprehensive review of the role of interventional radiologists in transcatheter interventions in various pathologies involving the main renal arteries with analysis of epidemiology, pathophysiology, newer interventional techniques, and management options.
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Affiliation(s)
- Ansan Joseph
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Divyesh Dandhaniya
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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10
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Narroway HG, Kovacic JL, Bourke BM, Louis-Johnsun M, Latif ER, Bourke VC. Selective Angioembolisation of Iatrogenic Renal Artery Pseudoaneurysms Following Minimally Invasive Urological Procedures: A Single Centre Case Series. Vasc Endovascular Surg 2022; 56:15385744221108041. [PMID: 35680559 DOI: 10.1177/15385744221108041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The purpose of this study was to report our centre's experience using selective angioembolisation in the treatment of iatrogenic renal artery pseudoaneurysms (RAP) following minimally invasive urological procedures. METHODS Our retrospective analysis included four consecutive patients treated with angioembolisation for iatrogenic RAP between October 2016 and October 2021. Data on demographics, minimally invasive urological intervention, clinical features, imaging findings, embolization procedure and perioperative details were collected. Rates of technical and clinical success, defined as 1. total occlusion of the extravasation site on completion digital subtraction angiography (DSA), and 2. resolution of symptoms, signs, and serum hemoglobin (Hb) derangements secondary to RAP, were analysed. Renal function, measured by serum creatinine (Cr) and estimated glomerular filtration rate (eGFR), was recorded prior to and post - angioembolisation procedure and compared. RESULTS Mean time between urological intervention and angioembolisation was 9 days (range, 2-17 days). Rates of technical and clinical success were 100% and 100% respectively. No additional angioembolisation procedures were required, and there were no peri or post-operative complications identified during mean follow-up of 662 days (range, 30-1845 days). Mean serum Cr prior to and post angioembolisation was 83 mmol/L and 79.5 mmol/L. Mean eGFR prior to and post angioembolisation was 73.8 and 77.8 mL/min/1.73 m2. In all patients, no significant difference was observed in serum Cr and eGFR prior to and post angioembolisation. CONCLUSION Iatrogenic renal artery pseudoaneurysms can occur following a range of minimally invasive urological procedures. This retrospective review highlights the utility of angioembolisation as a safe and effective treatment with high clinical and technical success rates. Further studies involving larger populations are required to validate its broader application.
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Affiliation(s)
- Harry G Narroway
- Department of Vascular Surgery, 90112Gosford Hospital, Gosford, NSW, Australia
| | - James L Kovacic
- Department of Urology, 90112Gosford Hospital, Gosford, NSW, Australia
| | - Bernard M Bourke
- Department of Vascular Surgery, 90112Gosford Hospital, Gosford, NSW, Australia
| | | | - Edward R Latif
- Department of Urology, 90112Gosford Hospital, Gosford, NSW, Australia
| | - Victor C Bourke
- Department of Vascular Surgery, 90112Gosford Hospital, Gosford, NSW, Australia
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McSweeney A, Tarpara A, Salvatore D, DiMuzio P, Nooromid M, Abai B. Coil embolization of ruptured distal renal artery pseudoaneurysm with gross hematuria and hemorrhagic shock. J Vasc Surg Cases Innov Tech 2022; 8:210-213. [PMID: 35493341 PMCID: PMC9048051 DOI: 10.1016/j.jvscit.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Renal artery pseudoaneurysms have been infrequently reported in the literature. In the present report, we have described a case of a ruptured renal artery pseudoaneurysm requiring coil embolization. A 49-year-old man had presented to our institution with a hypertensive emergency. Computed tomography revealed a 3.4-cm right renal artery pseudoaneurysm. Nonemergent coil embolization was planned for the following day. However, he became hypotensive, exsanguinating frank blood from the urethra. An arteriogram showed extravasation of contrast into the pseudoaneurysm sac, renal pelvis, and ureter, consistent with intrarenal pseudoaneurysm rupture. We have demonstrated coil embolization as a method of repairing a ruptured renal artery pseudoaneurysm with gross hematuria.
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12
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Pitchai S, Sun N, Pandey A, Manchikanti S. Ex vivo Repair of renal artery branch aneurysm in fibromuscular dysplasia. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Bagheri SM, Ghadamzadeh M, Chavoshi M. Percutaneous embolization of renal pseudoaneurysms: A retrospective study. Indian J Urol 2022; 38:296-301. [PMID: 36568457 PMCID: PMC9787449 DOI: 10.4103/iju.iju_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction We evaluated the efficacy of the mixture of autologous blood and a hemostatic agent, oxidized regenerative cellulose (ORC), as an alternative material for ultrasound (US)-guided percutaneous embolization of renal pseudoaneurysm (PA). Methods In this retrospective study, consecutive patients diagnosed with renal PA were included. The exclusion criteria were: PA of the main renal artery, tiny PA not visualized on the colour doppler ultrasonography, PA more than 3 cm in max diameter or extracapsular PA with the possibility of massive bleeding, and patients with a history of coagulation disorders. After localizing the PA, a mixture of autologous blood and ORC was injected under US guidance with a 15G coaxial needle. Patients were followed up for at least 6 months. Results Twenty-nine patients with PA were included, of which 26 had a history of percutaneous nephrolithotomy, and three patients had a history of renal biopsy (24 men and five women with an average age of 44.3 years). Gross hematuria was the most common mode of presentation. The mean size of the PA was 16.6 mm and the mean duration of follow-up was 9 months. The clinical and the technical success rate was 100%. The PA could be thrombosed in all the patients with a single-session of injection. No acute (hematoma, infection, and bleeding) or chronic (thromboembolic events, renal cortical atrophy, and recurrence) complications were seen. Conclusion Percutaneous embolization of renal PA under US guidance with a mixture of autologous blood and ORC is an efficient and easily available first-line method to treat this potentially life-threatening condition when endovascular embolization or other expensive thrombotic agents are not available.
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Affiliation(s)
- Seyed Morteza Bagheri
- Department of Radiology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghadamzadeh
- Department of Radiology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,
E-mail:
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14
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Leckie A, Tao MJ, Narayanasamy S, Khalili K, Schieda N, Krishna S. The Renal Vasculature: What the Radiologist Needs to Know. Radiographics 2021; 41:1531-1548. [PMID: 34328813 DOI: 10.1148/rg.2021200174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The physiologic role of the kidneys is dependent on the normal structure and functioning of the renal vasculature. Knowledge and understanding of the embryologic basis of the renal vasculature are necessary for the radiologist. Common anatomic variants involving the renal artery (supernumerary arteries and prehilar branching) and renal vein (supernumerary veins, delayed venous confluence, retroaortic or circumaortic vein) may affect procedures like renal transplantation, percutaneous biopsy, and aortic aneurysm repair. Venous compression syndromes (anterior and posterior nutcracker syndrome) can be symptomatic and can be diagnosed with a combination of radiologic features. Renal artery stenosis is commonly atherosclerotic and is diagnosed with Doppler US, CT angiography, or MR angiography. Fibromuscular dysplasia, the second most common cause of renal artery narrowing, has a characteristic string-of-beads appearance resulting from multifocal stenoses and dilatations. Manifestations of renal vasculitis differ depending on whether the affected vessels are large, medium, or small. Renal vascular injury is graded according to the American Association for the Surgery of Trauma (AAST) renal injury scale, which defines vascular injury and active bleeding in renal injuries. Both renal arteries and veins are affected by primary neoplasms or secondarily by neoplasms from adjacent structures. Differentiation between bland thrombus and tumor thrombus and the extent of involvement dictate management in malignancies, especially renal cell carcinoma. Aneurysms, pseudoaneurysms, arteriovenous malformations, and arteriovenous fistulas can affect renal vessels and can be diagnosed with specific imaging features. The radiologist has a critical role in identification of specific imaging characteristics and establishing the diagnosis in the varied pathologic conditions affecting the renal vasculature, which is critical for directing management. Thus, the renal vasculature should be an integral part of radiologists' checklist. ©RSNA, 2021.
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Affiliation(s)
- Ashley Leckie
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (A.L., M.J.T., K.K., S.K.); Department of Radiology, University of Iowa, Iowa City, Iowa (S.N.); and Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (N.S.)
| | - Mary Jiayi Tao
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (A.L., M.J.T., K.K., S.K.); Department of Radiology, University of Iowa, Iowa City, Iowa (S.N.); and Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (N.S.)
| | - Sabarish Narayanasamy
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (A.L., M.J.T., K.K., S.K.); Department of Radiology, University of Iowa, Iowa City, Iowa (S.N.); and Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (N.S.)
| | - Korosh Khalili
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (A.L., M.J.T., K.K., S.K.); Department of Radiology, University of Iowa, Iowa City, Iowa (S.N.); and Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (N.S.)
| | - Nicola Schieda
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (A.L., M.J.T., K.K., S.K.); Department of Radiology, University of Iowa, Iowa City, Iowa (S.N.); and Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (N.S.)
| | - Satheesh Krishna
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (A.L., M.J.T., K.K., S.K.); Department of Radiology, University of Iowa, Iowa City, Iowa (S.N.); and Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (N.S.)
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15
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Clark J, Chandrasekar T. 'Case of the Month' from Thomas Jefferson University, Philadelphia, PA, USA: a large renal pseudoaneurysm masquerading as advanced renal cell carcinoma. BJU Int 2021; 128:158-161. [PMID: 34318982 DOI: 10.1111/bju.15407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica Clark
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Günay N, Pınarbaşı AS, Dursun İ, Tunçay A, Demirci D, Kahriman G, Düşünsel R. Calcified renal artery aneurism in the right kidney causing hypertension. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:266-270. [PMID: 32129223 DOI: 10.4103/1319-2442.279951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The renal artery aneurysm (RAA) is defined as a renal artery segment that is twofold dilated than normally. It is very rare in children and often asymptomatic. However, it can cause severe hypertension (HTN) and kidney failure. Herein, we report a 14-year-old boy who with RAA which was presented with back pain. His medical history was remarkable for essential HTN that was refractory to antihypertensive medications. Plain abdominal radiography revealed calcification at the right flank area. On computed tomography images, calcification surrounding the right renal artery was detected. Selective renal angiography showed totally occluded right renal artery segment. Calcified RAA was detected on the operation and removed. Two months after, blood pressure was under control, but there was no functioning right kidney on DMSA. We think that clinicians should keep in mind RAA in the differential diagnosis of treatment-resistant HTN and use other radiologic methods even if Doppler is normal.
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Affiliation(s)
- Neslihan Günay
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Aydın Tunçay
- Department of Cardiovascular Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Deniz Demirci
- Department of Urology, Division of Pediatric Urology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Güven Kahriman
- Department of Radiodiagnostics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ruhan Düşünsel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
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17
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A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient. SRP ARK CELOK LEK 2021. [DOI: 10.2298/sarh210303080s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. The renal artery and segmental renal artery pseudoaneurysm is a
rare and usually asymptomatic vascular lesion which in most of the cases
thrombose spontaneously, but at same time it can be a source of
life-threatening hemorrhage and shock. Today, these pseudoaneurysms are
discovered with increasing frequency due to unrelated abdominal imaging or
on screening work-ups for hypertension, as well as widespread use of
angiography. Typically, they are seen in patients after trauma,
inflammation, or renal surgery or biopsy. Case outline. In our case, a
52-year-old male patient with no prior history of surgery, significant
abdominal trauma and systemic disease, presented with left flank pain and
signs of hypovolemic shock that manifested before the admission in the
surgical emergency room. The CT scan promptly demonstrated rupture of large
retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The
angiography confirmed the rupture of the renal artery pseudoaneurysm. The
patient had the urgent operation. A life-saving nephrectomy was performed
while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated.
The fourteen days after surgery the patient was discharged fully recovered,
with normal diuresis and serum levels of creatinine and urea within
referential values. During the period of hospitalization, he was diagnosed
and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the
following hemorrhage into the intraperitoneal cavity and retroperitoneum is
a life-threatening condition, as proven with this case in which hypovolemic
shock manifested before the admission. We would like to highlight the
importance of high blood-pressure control and the importance of regular
check-ups.
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18
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Karaosmanoglu AD, Uysal A, Akata D, Ozmen MN, Karcaaltincaba M. Role of imaging in visceral vascular emergencies. Insights Imaging 2020; 11:112. [PMID: 33057847 PMCID: PMC7561664 DOI: 10.1186/s13244-020-00913-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Differential diagnosis in non-traumatic acute abdomen is broad and unrelated diseases may simulate each other from a clinical perspective. Despite the fact that they are not as common, acute abdominal pain due to diseases related to visceral vessels may be life-threating if not detected and treated promptly. Thrombosis, dissection, and aneurysm in the abdominal visceral arteries or thrombosis in visceral veins may cause acute abdominal pain. Imaging with appropriate protocoling plays a fundamental role in both early diagnosis and determination of the treatment approach in these cases where early treatment can be life-saving. Computed tomography (CT) appears to be the most effective modality for the diagnosis as it provides high detail images in a very short time. Patient cooperation is also a less concern as compared to magnetic resonance imaging (MRI). As the imaging findings may sometimes be really subtle, diagnosis may be difficult especially to inexperienced imagers. Correct protocoling is also very critical to detect arterial abnormalities as visceral arterial abnormalities may not be detectable in portal phase only abdominal CT scans. In this article, we aimed to increase awareness among imaging specialists to these not very common causes of acute abdomen.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Xu JJ, Rasuli P, Burns KD. Case Report: Segmental Arterial Mediolysis, a Rare Cause of Hypertension. Can J Kidney Health Dis 2020; 7:2054358120950885. [PMID: 32913655 PMCID: PMC7444149 DOI: 10.1177/2054358120950885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
Rationale: The differential diagnosis for hypertension with elevated plasma renin is broad. This case illustrates one of the rarer, and therefore underrecognized, causes of high renin hypertension. Presenting concerns of the patient: A 41-year-old man with a medical history significant for multiple ischemic strokes and dyslipidemia presented for assessment of decreased renal function and resistant hypertension. His initial workup for secondary causes of hypertension was remarkable for an elevated plasma renin and normal aldosterone. Further investigation with computed tomography (CT) angiography was performed, which demonstrated multiple bilateral renal aneurysms and infarcts. Diagnoses: After ruling out other potential causes of bilateral renal aneurysms and infarcts, a diagnosis of segmental arterial mediolysis (SAM) was made. Interventions: Optimization of antihypertensive regimen, counseling regarding regular home blood pressure monitoring, and smoking cessation. Outcomes: The patient achieved excellent blood pressure control, stable renal function, and had no further strokes or other vascular events. Teaching points: Our case demonstrates the importance of considering SAM in the diagnosis of hypertension with elevated plasma renin and as a vasculitis mimic. It also highlights the importance of considering renal vascular imaging in the workup of resistant hypertension.
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Affiliation(s)
- Jieqing Jessica Xu
- Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Pasteur Rasuli
- Department of Radiology, Division of Angiography and Interventional Radiology, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada
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20
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Gorsi U, Soundararajan R, Jugpal TS, Lal A, Shetty SB, Kalra N, Kang M, Sandhu MS. Interventional Radiology Management of Renal Pseudoaneurysms: Experience at a Tertiary Care Hospital. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1715026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objectives Renal pseudoaneurysms are multifactorial in origin, and angioembolization remains the mainstay of treatment. Few case reports have also described percutaneous embolization using glue or thrombin. Our study aimed to evaluate the predictors of active bleed by analyzing their etiology, morphology, imaging features, and treatment adopted. To the best of our knowledge, this is the largest such study done in India.
Methods This was a retrospective study of patients treated for renal pseudoaneurysms between 2014 and 2019. We reviewed their clinical data, treatment modalities used, and clinical outcomes. We also assessed computed tomography angiography (CTA) and conventional angiography images.
Results A total of 79 patients (54 males and 25 females) were included in the study. The mean age was 39.5 years (range 15–83 years). The most common cause was renal biopsy, followed by surgery. Of these, three patients (3.9%) had more than one lesion and 57% of pseudoaneurysms were seen in lower polar arteries. Active contrast extravasation was seen in 15.2% (n = 12) of the patients and 21.5% (n = 17) showed lobulations in CT and digital substraction angiography. The mean size of the pseudoaneurysms was 1.17 cm (SD 0.7); 22.8% of pseudoaneurysms were wide necked. The embolization was approached by endovascular (89.9%), percutaneous (10.1%), or both (1.3%) routes. Embolization was performed using microcoils (78.5%), gel foam (12.7%), N-butyl cyanoacrylate glue (8.9%), polyvinyl alcohol (8.9%), and thrombin (5.1%) either as a single agent or in combination. The technical success was achieved in all cases after the first procedure. Pseudoaneurysms with a wide neck (p = 0.03) and lobulations (p = 0.002) were associated with active contrast extravasation. Episodes of rebleeding were seen at a younger age (p-value = 0.02).
Conclusion Minimally invasive methods remain the cornerstone in the management of renal pseudoaneurysms with high success rates. The morphology of pseudoaneurysms can help predict the risk of active bleeding and decide the type of intervention. Direct percutaneous injection into the aneurysm sac is an alternate technique and should be considered when an endovascular approach is challenging.
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Affiliation(s)
- Ujjwal Gorsi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tejeshwar Singh Jugpal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Shetty
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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21
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Bedayat A, Hassani C, Prosper AE, Chalian H, Khoshpouri P, Ruehm SG. Recent Innovations in Renal Vascular Imaging. Radiol Clin North Am 2020; 58:781-796. [DOI: 10.1016/j.rcl.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Successful Endovascular Treatment of a Giant Intraparenchymal Renal Artery Pseudoaneurysm in a Young Female Patient. EJVES Short Rep 2019; 43:4-7. [PMID: 31049422 PMCID: PMC6479093 DOI: 10.1016/j.ejvssr.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Pseudoaneurysms of the renal artery are fairly uncommon and mostly asymptomatic. They develop mostly in the right renal artery and in female patients. Report In this report, a female patient with an intraparenchymal renal artery pseudoaneurysm with one year follow up is described. She presented with non-specific abdominal pain. A computed tomography scan revealed hydronephrosis of the right kidney and a giant, intracapsular, contained rupture of a pseudoaneurysm of the right renal artery. The patient was admitted to hospital and underwent a successful selective embolisation of the pseudoaneurysm. Follow up at one year showed normal renal function and an excluded aneurysm. Discussion Although relatively uncommon, renal artery pseudoaneurysms should be considered in the work up of patients with colicky flank pain. As a treatment option, endovascular approaches are appealing because they are less invasive. Successful treatment can prevent resection of the affected kidney. This report describes the rare case of a young female patient with contained rupture of a right renal artery pseudoaneurysm. The pseudoaneurysm was treated by endovascular coiling, preserving the kidney and its function. A spontaneous pseudoaneurysm is a rare cause of colicky flank pain. Endovascular treatment is a good treatment option. Most pseudoaneurysms present after direct penetrating injury and not spontaneously.
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23
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Pfister K, Kasprzak PM, Jung EM, Müller-Wille R, Wohlgemuth W, Kopp R, Schierling W. Contrast-enhanced ultrasound to evaluate organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms. Clin Hemorheol Microcirc 2017; 64:689-698. [PMID: 27802212 DOI: 10.3233/ch-168003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms (VAAs) by contrast-enhanced ultrasound (CEUS) and colour-coded duplex sonography (CCDS). METHOD AND MATERIALS Between April 1995 to January 2016, 168 patients (78 males, 90 females; median age: 62 years) were diagnosed with VAAs at our hospital site. 60/168 patients (36%) fulfilled treatment criteria and had either open (29/60, 48%) or endovascular (31/60, 52%) aneurysm repair. Patients' characteristics and presentations were consecutively reviewed. Technical success and organ microvascularization were determined by CCDS/CEUS and correlated to computed tomography angiography (CTA) or magnetic resonance imaging (MRI). RESULTS 18/60 patients (30%) presented with acute bleeding. 16/18 emergency patients (89%) were treated by endovascular means. After emergency treatment, two patients showed segmental liver malperfusion by CEUS and CTA. One small bowel resection had to be performed.42/60 patients (70%) were electively treated. 27/42 patients (64%) had open and 15/42 (36%) endovascular aneurysm repair. There were no liver or bowel infarctions after elective treatment of hepatic or mesenteric artery aneurysms (n = 13) in CCDS/CEUS and in CTA. Treatment of patients with splenic or renal artery aneurysms led to partial or complete organ loss in 42% (8/19) after operative and in 50% (5/10) after endovascular treatment (p < 0.05). CONCLUSION The endovascular approach is the preferred therapeutic option in emergency to control bleeding. In contrast to hepatic or mesenteric procedures, patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully because of a high rate of partial or complete organ loss demonstrated by CEUS - either after open or endovascular aneurysm repair.
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Affiliation(s)
- Karin Pfister
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Piotr M Kasprzak
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ernst M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Walter Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Reinhard Kopp
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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24
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Al-Katib S, Shetty M, Jafri SMA, Jafri SZH. Radiologic Assessment of Native Renal Vasculature: A Multimodality Review. Radiographics 2017; 37:136-156. [DOI: 10.1148/rg.2017160060] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Chen A, DeBartolo M, Darras F, Ferretti J, Wasnick R. Renal Artery Pseudoaneurysm in Kawasaki Disease. Urology 2016; 98:165-166. [DOI: 10.1016/j.urology.2016.05.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
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Titze N, Ivanukoff V, Fisher T, Pearl G, Grimsley B, Shutze WP. Surgical repair of renal artery aneurysms. Proc (Bayl Univ Med Cent) 2015; 28:499-501. [PMID: 26424954 DOI: 10.1080/08998280.2015.11929322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The pathogenesis of renal artery aneurysms (RAAs) is degenerative, which eventually leads to weakening of the vessel wall and, in extreme cases, rupture. RAAs are a rare occurrence. Patients generally are asymptomatic, with a small number presenting with uncontrollable hypertension or hematuria. Most RAAs are discovered incidentally on imaging and do not pose an immediate health threat. However, the risk of rupture is an indication for prophylactic repair in certain patients. Interest in interventional radiologic procedures in the management of RAAs has recently increased; however, open repair should still be considered in select instances. In this case series, we present three patients for whom an open approach was indicated and performed.
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Affiliation(s)
- Nicole Titze
- Texas A&M Health Science Center College of Medicine (Titze) and the Division of Vascular Surgery, Baylor University Medical Center at Dallas (Ivanukoff, Fisher, Pearl, Grimsley, Shutze)
| | - Victoria Ivanukoff
- Texas A&M Health Science Center College of Medicine (Titze) and the Division of Vascular Surgery, Baylor University Medical Center at Dallas (Ivanukoff, Fisher, Pearl, Grimsley, Shutze)
| | - Tammy Fisher
- Texas A&M Health Science Center College of Medicine (Titze) and the Division of Vascular Surgery, Baylor University Medical Center at Dallas (Ivanukoff, Fisher, Pearl, Grimsley, Shutze)
| | - Gregory Pearl
- Texas A&M Health Science Center College of Medicine (Titze) and the Division of Vascular Surgery, Baylor University Medical Center at Dallas (Ivanukoff, Fisher, Pearl, Grimsley, Shutze)
| | - Brad Grimsley
- Texas A&M Health Science Center College of Medicine (Titze) and the Division of Vascular Surgery, Baylor University Medical Center at Dallas (Ivanukoff, Fisher, Pearl, Grimsley, Shutze)
| | - William P Shutze
- Texas A&M Health Science Center College of Medicine (Titze) and the Division of Vascular Surgery, Baylor University Medical Center at Dallas (Ivanukoff, Fisher, Pearl, Grimsley, Shutze)
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27
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Successfully treated isolated renal artery pseudoaneurysm in a patient with Behçet's disease. Kidney Res Clin Pract 2015; 35:123-6. [PMID: 27366669 PMCID: PMC4919565 DOI: 10.1016/j.krcp.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/24/2015] [Accepted: 09/04/2015] [Indexed: 11/24/2022] Open
Abstract
Renal artery aneurysms and pseudoaneurysms are an uncommon clinical problem with a low incidence rate. They are abnormal dilatations of the vessel lumen with some different natures. However, the rupture of an aneurysm and pseudoaneurysm is the most dreaded complication because it causes death of the patient. There are many causes of renal artery aneurysm and pseudoaneurysm, including Behçet's disease; however, renal involvement in Behçet's disease is less frequent. We report a case of renal artery pseudoaneurysm induced by Behçet's disease and treated successfully with coil embolization. A 56-year-old woman with Behçet's disease presented with an incidental left renal artery pseudoaneurysm measuring 18 mm. We successfully performed endovascular treatment with coil embolization instead of surgical treatment.
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28
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Altiparmak IH, Erkus ME, Gunebakmaz O, Sezen Y, Kaya Z, Demirbag R. A curable cause of hypertension: renal artery pseudoaneurysm. Wien Klin Wochenschr 2015. [PMID: 26223196 DOI: 10.1007/s00508-015-0822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Renal artery aneurysms and pseudoaneurysms are rare vascular abnormalities. These anomalies, which are usually asymptomatic, may be associated with hypertension. Here, we present the successful treatment of a renal artery pseudoaneurysm in a patient with hypertension, with an overview of the literature.
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Affiliation(s)
| | | | - Ozgur Gunebakmaz
- Medical Faculty, Department of Cardiology, Harran University, Sanliurfa, Turkey
| | - Yusuf Sezen
- Medical Faculty, Department of Cardiology, Harran University, Sanliurfa, Turkey
| | - Zekeriya Kaya
- Medical Faculty, Department of Cardiology, Harran University, Sanliurfa, Turkey
| | - Recep Demirbag
- Medical Faculty, Department of Cardiology, Harran University, Sanliurfa, Turkey
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29
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Almeida-Lopes J, Brandão D, Mansilha A. Técnica de embolização assistida por stent de aneurisma da artéria renal. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/s1646-706x(14)70054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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30
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Pseudoaneurisma intrarrenal secundario a nefrolitotomía percutánea: revisión de la literatura y reporte de un caso. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Complete Renal Artery Embolization in a Comorbid Patient with an Arteriovenous Malformation. Case Rep Urol 2014; 2014:856059. [PMID: 24716086 PMCID: PMC3971545 DOI: 10.1155/2014/856059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/18/2014] [Indexed: 11/23/2022] Open
Abstract
Renal arteriovenous malformations are uncommon and are rarely a cause for presentation. However, they can occasionally pose life-threatening problems. We present a case of an elderly female who underwent a complete left renal artery embolization, following a difficult presentation complicated by advanced dementia and multiple comorbidities. This is the first documented case of complete renal artery embolisation used to treat a renal AVM.
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32
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Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings. J Am Coll Radiol 2013; 10:789-94. [DOI: 10.1016/j.jacr.2013.05.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 02/06/2023]
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Lozano JD, Munera F, Anderson SW, Soto JA, Menias CO, Caban KM. Penetrating wounds to the torso: evaluation with triple-contrast multidetector CT. Radiographics 2013; 33:341-59. [PMID: 23479700 DOI: 10.1148/rg.332125006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Penetrating injuries account for a large percentage of visits to emergency departments and trauma centers worldwide. Emergency laparotomy is the accepted standard of care in patients with a penetrating torso injury who are not hemodynamically stable and have a clinical indication for exploratory laparotomy, such as evisceration or gastrointestinal bleeding. Continuous advances in technology have made computed tomography (CT) an indispensable tool in the evaluation of many patients who are hemodynamically stable, have no clinical indication for exploratory laparotomy, and are candidates for conservative treatment. Multidetector CT may depict the trajectory of a penetrating injury and help determine what type of intervention is necessary on the basis of findings such as active arterial extravasation and major vascular, hollow viscus, or diaphragmatic injuries. Because multidetector CT plays an increasing role in the evaluation of patients with penetrating wounds to the torso, the radiologists who interpret these studies should be familiar with the CT findings that mandate intervention.
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Affiliation(s)
- J Diego Lozano
- Department of Radiology, University of Miami Leonard Miller School of Medicine, University of Miami Health System, Jackson Memorial Hospital, and Ryder Trauma Center, 1611 NW 12th Ave, West Wing 279, Miami, FL 33136, USA
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Asymptomatic renal pseudoaneurysm after percutaneous renal biopsy. Kidney Res Clin Pract 2013; 32:87-9. [PMID: 26877921 PMCID: PMC4713914 DOI: 10.1016/j.krcp.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 01/20/2023] Open
Abstract
A 37-year-old man was referred to Division of Nephrology for a new renal cystic lesion that was found on ultrasonography. Four years prior to presentation, a percutaneous renal biopsy had been performed. Computed tomography scan showed a 4.4-cm-sized renal artery pseudoaneurysm in the left kidney. Selective renal angiography revealed a pseudoaneurysm in the left lower pole of the kidney. The renal pseudoaneurysm was successfully embolized with coil. Follow-up Doppler ultrasonography showed no internal blood flow into the aneurysmal sac. His renal function remained stable after coil embolization.
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Endovascular treatment of renal aneurysms: A series of 18 cases. Eur J Radiol 2012; 81:3973-8. [DOI: 10.1016/j.ejrad.2012.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/17/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022]
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Prajapati H, McCallum A, Finlay E. Hypertension, secondary to a renal artery aneurysm, treated by ex vivo aneurysm repair and autotransplantation. BMJ Case Rep 2012; 2012:bcr-2012-007362. [PMID: 23166176 DOI: 10.1136/bcr-2012-007362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypertension is becoming a more common problem in childhood and adolescence. About 5-10% of paediatric patients with hypertension have underlying renovascular disease. Although renal artery aneurysms (RAAs) are an uncommon cause of disease of the renal vessels, they are recognised as a cause of hypertension. We describe a 15-year-old man with symptomatic hypertension who after extensive investigation was found to have a right RAA. Our patient responded to conservative management with two antihypertensive agents, but as a young sports enthusiast, he was keen to pursue more definitive options. Complex anatomy of the aneurysm precluded the use of endovascular treatment. Surgical options were explored, and after counselling, our patient underwent a nephrectomy, ex vivo aneurysm repair and autotransplantation with which his hypertension resolved. Our case highlights the difficulty of diagnosing RAAs in hypertensive patients and that, in carefully selected patients, invasive surgical intervention of RAAs is a viable treatment option.
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Affiliation(s)
- Hitesh Prajapati
- Department of Paediatric Nephrology, Leeds Teaching Hospitals Trust, Leeds, UK.
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De Mauri A, Brambilla M, Izzo C, Matheoud R, Chiarinotti D, Carriero A, Stratta P, De Leo M. Cumulative radiation dose from medical imaging in kidney transplant patients. Nephrol Dial Transplant 2012; 27:3645-51. [PMID: 22619314 DOI: 10.1093/ndt/gfs145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many patients undergoing kidney transplant are exposed to multiple examinations that increase cumulative effective doses (CEDs) of ionizing radiation, no data are available characterizing their total longitudinal radiation burden and relating radiation burden with risk factors for more exposure. METHODS We did a retrospective cohort study of 92 patients (mean age 52 years; range: 20-75 years) who underwent kidney transplant at University Hospital, Novara, Italy, that evaluated all following medical imaging procedures involving ionizing radiation undergone beginning June 2007, and all subsequent procedures through August 2011, at the centre. RESULTS The mean and median annual CED were 17.2 and 4.9 millisieverts (mSv) per patient-year. The mean and median total CED per patient over the study period were 46.1 and 17.3 mSv, respectively. Twenty-eight and 12% of patients had total CED >50 and 100 mSv, values which are associated with a good or strong evidence of an increased cancer mortality risk, respectively. Computed tomography scanning accounted for 73% of the total CED. The annual CED was significantly higher in incident patients and in patients with ischaemic heart disease and cancer. CONCLUSION In this institution, multiple testing of kidney transplant patients was common in many patients associated with high cumulative estimated doses of ionizing radiation.
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Affiliation(s)
- Andreana De Mauri
- Nephrology Department, University Hospital Maggiore della Carità, Novara, Italy
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Surgical treatment of a ruptured giant renal artery aneurysm--case report and literature review. POLISH JOURNAL OF SURGERY 2011; 83:343-6. [PMID: 22166552 DOI: 10.2478/v10035-011-0053-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Renal artery aneurysms are the second most common visceral artery aneurysms after splenic artery aneurysms, and before hepatic artery aneurysms. The study presented a case of a ruptured giant right renal artery aneurysm in a female patient. The presented case is worth mentioning, due to the giant size of the lesion. The diameter of the aneurysm exceeded 10 cm. Available literature data mentioned single reports of such large aneurysms located in the renal arteries. In spite of the fact that renal artery aneurysms are the second most common visceral artery aneurysms, their management is accompanied by some controversy. Literature data mentioned the dominance of endovascular techniques. However, surgical treatment remains to be the most effective and radical method.
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Ciudin A, Huguet J, García-Larrosa A, Musquera M, Alvarez-Vijande JR, José Ribal M, Alcaraz A. [Delayed bleeding after partial nephrectomy. Management with selective embolization]. Actas Urol Esp 2011; 35:615-9. [PMID: 21764183 DOI: 10.1016/j.acuro.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/22/2011] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Bleeding after partial nephrectomy can be immediate or delayed and may have severe consequences. The incidence of this complication is low. The most frequent cause of delayed bleeding is arterial pseudoaneurysm. Superselective embolization is a feasible therapeutic option that has shown good results. OBJECTIVE To evaluate treatment and outcomes of delayed bleeding in our series of patients with partial nephrectomy. MATERIAL AND METHODS We performed a retrospective study of our database of partial nephrectomies. Patients who developed delayed bleeding (after discharge) were identified. Clinical histories were reviewed and data on presentation, diagnosis, treatment and outcomes were analyzed. RESULTS Among our series of patients undergoing partial nephrectomy, three developed delayed bleeding (1.3%). Symptom onset occurred 17 to 25 days after surgery and consisted of hematuria or lumbar pain. Diagnosis was provided through ultrasound, abdominal computed tomography and renal angiography. In all three patients, a complicated pseudoaneurysm was diagnosed and all patients underwent renal artery catheterization with selective renal artery embolization. In all patients, immediate control of bleeding was achieved. Outcome after a follow-up of 61 to 92 months was favorable. CONCLUSIONS Selective vascular embolization is the treatment of choice of renal pseudoaneurysm after partial nephrectomy in hemodynamically stable patients.
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Affiliation(s)
- A Ciudin
- Servicio de Urología, Instituto Clínico de Nefrología y Urología, Hospital Clínic, Barcelona, España.
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Thrombosed Aneurysm of a Segmental Renal Artery Branch. Diagnostic and Therapeutic Approach. Urologia 2011; 78 Suppl 18:39-44. [DOI: 10.5301/ru.2011.8770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 11/20/2022]
Abstract
Introduction We present the case of a 37-year-old man with a thrombosed aneurysm of a segmental branch of the left renal artery, which was diagnosed after a radiological investigation for colic-like pain, and treated conservatively with endovascular approach. Materials and Methods After repeated episodes of colic-like pain in his left side with normal ultrasound of the urinary tract, A.R. (37 years old) undergoes a CT urogram of the abdomen, which shows a complete thrombosis of the middle third of the left renal artery, which is associated with hypoperfusion of the lower middle third of the kidney with suspected ischemia of the lower pole. In confirmation of the previous clinical scenario, we proceed with a urgent angiography, which identifies a pseudoaneurysm, partially thrombosed, of the segmental branch of the left renal artery at the lower middle pole. During the hospitalization, the clinical picture is complicated by an unstable arterial hypertension associated with headache and nausea. A renal scintigraphy confirms a severe impairment of the renal function mainly at the level of the middle third of the lower left kidney. The total glomerular filtration rate sec. Gates was equal to 64.3 mL/min with a percentage breakdown of the global renal function of 28% to the right and 72% to the left. The location of the vascular defect argues for endovascular intervention in the attempt to preserve the remaining renal parenchyma. We proceed with a standard angiography with selective access to the left renal artery with a catheter via femoral artery Cobra 5Fx80 TERUSMO cm. The tortuosity of the thrombus and the angle of the aneurysm site prevent, despite several attempts, the passage of the guide wire for a possible stenting and fibrinolysis. We opt for the placement of 5 spirals at the aneurysm (Boston Soft GDC-10 SR 360 7mm x 15cm), in order to preserve the residual parenchyma, excluding the aneurysmal artery at risk of rupture and extent of the thrombus. Results Immediately after the procedure, the clinical picture remained stable with complete remission of painful symptoms and with a good blood pressure control. At about 6 months, the renal scintigraphy shows a filtered global impairment of 70%, 30% for the left kidney, a slight improvement over the previous controls. The blood pressure remains within the limits with amlodipine 5 mg. Conclusions Renal artery aneurysms are uncommon and occur in approximately 0.09% of the general population. The etiopathogenesis at a young age is often dysplastic in nature and the diagnosis is made incidentally or during evaluation of related symptoms, being asymptomatic until they become complicated. Their treatment is proposed to prevent complications such as rupture or thrombosis. Given the extreme variability of presentation, the surgical technique, traditional or endoscopic, is at the surgeon's discretion. In our case, we opted for a conservative approach since the degree of renal parenchyma impairment and the patient's hemodynamic condition allowed to.
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