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Dreyfus I, Zilinyi R, Radhakrishnann J, Parikh SA. Therapy for Renal Artery Stenosis: A Call for Change. J Endovasc Ther 2024; 31:522-532. [PMID: 36415917 DOI: 10.1177/15266028221134884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
CLINICAL IMPACT We present a brief case description of a patient who benefitted from stenting in ARAS and provide a comprehensive review of ARAS; its prevalence, pathophysiology, clinical manifestations, diagnosis and treatment. We review the evidence for and against stenting in ARAS as well as consensus guidelines for stenting. Our review is valuable as we argue that stenting in ARAS is underutilized and the randomized control data for stenting in those patients who may benefit most is lacking. Our review will provide an important perspective for clinicians faced with decisions of how to treat ARAS.
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Affiliation(s)
- Isaac Dreyfus
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert Zilinyi
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jai Radhakrishnann
- Division of Nephrology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
- Center for Interventional Cardiovascular Care and Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Xiong LQ, Ma LL, Shi LY, Pan NN, Ai K, Zhao JX, He DL, Hang G. Functional magnetic resonance imaging for staging chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 2024:10.1007/s11255-024-04055-z. [PMID: 38632173 DOI: 10.1007/s11255-024-04055-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: 12/11/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION The commonly used clinical indicators are not sensitive and comprehensive enough to evaluate the early staging of chronic kidney disease (CKD). This study aimed to evaluate the differences in arterial spin labeling (ASL) and blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-MRI) parameter values among patients at various stages of chronic kidney disease and healthy individuals. METHODS Electronic databases PubMed, Web of Science, Cochrane, and Embase were searched from inception to March 29, 2024, to identify relevant studies on ASL and BOLD in CKD. The renal blood flow (RBF) and apparent relaxation rate (R2*) values were obtained from healthy individuals and patients with various stages of CKD. The meta-analysis was conducted using STATA version 12.0. The random-effects model was used to obtain estimates of the effects, and the results were expressed as 95% confidence intervals (CIs) and mean differences (MDs) of continuous variables. RESULTS A total of 18 published studies were included in this meta-analysis. The cortical RBF and R2* values and medulla RBF values were considerably distinct between patients with various stages of CKD and healthy controls (MD, - 78.162; 95% CI, - 85.103 to - 71.221; MD, 2.440; 95% CI, 1.843 to 3.037; and MD, - 36.787; 95% CI, - 47.107 to - 26.468, respectively). No obvious difference in medulla R2* values was noted between patients with various stages of CKD and healthy controls (MD, - 1.475; 95% CI, - 4.646 to 1.696). CONCLUSION ASL and BOLD may provide complementary and distinct information regarding renal function and could potentially be used together to gain a more comprehensive understanding of renal physiology.
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Affiliation(s)
- Lian Qiu Xiong
- First Clinical School of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Li Li Ma
- First Clinical School of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Liu Yan Shi
- First Clinical School of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ni Ni Pan
- First Clinical School of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Kai Ai
- Philip Healthcare, Xi'an, China
| | - Jian Xin Zhao
- First Clinical School of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Di Liang He
- First Clinical School of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Gang Hang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Ren D, Zhou B, Li J, Guo S, Guo B. Control of the injection velocity of embolic agents in embolization treatment. Biomed Eng Online 2023; 22:58. [PMID: 37316898 DOI: 10.1186/s12938-023-01126-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Embolization is a common treatment method for tumor-targeting, anti-organ hyper-function, and hemostasis. However, the injection of embolic agents largely depends on the experiences of doctors, and doctors need to work in an X-ray environment that hurts their health. Even for a well-trained doctor, complications such as ectopic embolism caused by excessive embolic agents are always inevitable. RESULTS This paper established a flow control curve model for embolic injection based on local arterial pressure. The end-vessel network was simplified as a porous media. The hemodynamic changes at different injection velocities and embolization degrees were simulated and analyzed. Sponge, a typical porous medium, was used to simulate the blocking and accumulation of embolic agents by capillary networks in the in vitro experimental platform. CONCLUSIONS The simulation and experimental results show that the local arterial pressure is closely related to the critical injection velocity of the embolic agent reflux at a certain degree of embolization. The feasibility of this method for an automatic embolic injection system is discussed. It is concluded that the model of the flow control curve of embolic injection can effectively reduce the risk of ectopic embolism and shorten the time of embolic injection. The clinical application of this model is of great value in reducing radiation exposure and improving the success rate of interventional embolization.
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Affiliation(s)
- Dongcheng Ren
- Academy for Engineering and Technology, Fudan University, 220 Handan Rd., Shanghai, China
- Shanghai Engineering Research Center of AI & Robotics, 539 Handan Rd., Shanghai, 200433, China
- Engineering Research Center of AI & Robotics, Ministry of Education, 539 Handan Rd., Shanghai, China
| | - Bo Zhou
- Department of Interventional Radiology, Fudan University Zhongshan Hospital, 180 Fenglin Rd., Shanghai, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Rd., Shanghai, China
| | - Jiasheng Li
- Academy for Engineering and Technology, Fudan University, 220 Handan Rd., Shanghai, China
- Shanghai Engineering Research Center of AI & Robotics, 539 Handan Rd., Shanghai, 200433, China
- Engineering Research Center of AI & Robotics, Ministry of Education, 539 Handan Rd., Shanghai, China
| | - Shijie Guo
- Academy for Engineering and Technology, Fudan University, 220 Handan Rd., Shanghai, China.
- Shanghai Engineering Research Center of AI & Robotics, 539 Handan Rd., Shanghai, 200433, China.
- Engineering Research Center of AI & Robotics, Ministry of Education, 539 Handan Rd., Shanghai, China.
| | - Baolei Guo
- Department of Vascular Surgery, Fudan University Zhongshan Hospital, 180 Fenglin Rd., Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Rd., Shanghai, China.
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Bhalla V, Textor SC, Beckman JA, Casanegra AI, Cooper CJ, Kim ESH, Luther JM, Misra S, Oderich GS. Revascularization for Renovascular Disease: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e128-e143. [PMID: 35708012 DOI: 10.1161/hyp.0000000000000217] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renovascular disease is a major causal factor for secondary hypertension and renal ischemic disease. However, several prospective, randomized trials for atherosclerotic disease failed to demonstrate that renal revascularization is more effective than medical therapy for most patients. These results have greatly reduced the generalized diagnostic workup and use of renal revascularization. Most guidelines and review articles emphasize the limited average improvement and fail to identify those clinical populations that do benefit from revascularization. On the basis of the clinical experience of hypertension centers, specialists have continued selective revascularization, albeit without a summary statement by a major, multidisciplinary, national organization that identifies specific populations that may benefit. In this scientific statement for health care professionals and the public-at-large, we review the strengths and weaknesses of randomized trials in revascularization and highlight (1) when referral for consideration of diagnostic workup and therapy may be warranted, (2) the evidence/rationale for these selective scenarios, (3) interventional and surgical techniques for effective revascularization, and (4) areas of research with unmet need.
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Aremu A, Igbokwe M, Olatise O, Lawal A, Maduadi K. Anatomical variations of the renal artery: a computerized tomographic angiogram study in living kidney donors at a Nigerian Kidney Transplant Center. Afr Health Sci 2021; 21:1155-1162. [PMID: 35222578 PMCID: PMC8843298 DOI: 10.4314/ahs.v21i3.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Understanding of the renal vascular anatomy is key to a safe and successful donor nephrectomy, which ultimately impacts on the renal graft function and survival in kidney transplant recipients. OBJECTIVE To report the various anatomical configurations of the renal artery identified in living kidney donors in a Nigerian kidney transplant institution. MATERIALS AND METHODS The computerized tomography angiograms of 100 consecutive living kidney donors were prospectively reviewed over an 18-month period. Anatomical variations of the renal arteries including accessory arteries and early divisions were noted. Duration of surgery and ischemic time were recorded intra-operatively. Data analysis was carried out using IBM SPSS version 20. RESULTS There were variations in renal artery configuration in 50 (50%) cases, 32% were accessory renal arteries while 18% were early branches of the renal artery. The classical bilateral solitary renal arteries were found in 50 (50%) of potential donors. There was statistically significant longer operating and ischemic time in donors with multiple renal arteries as compared with solitary arteries (p<0.05). CONCLUSION There are a wide variety of renal artery configurations seen in potential kidney donors. The classical solitary renal artery remains the commonest and most favourable configuration for donor nephrectomy and transplantation.
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Affiliation(s)
- Abayomi Aremu
- Urology Division, Zenith Medical and Kidney Centre, Gudu, Abuja, Nigeria
| | - Martin Igbokwe
- Urology Division, Zenith Medical and Kidney Centre, Gudu, Abuja, Nigeria
| | - Olalekan Olatise
- Nephrology Unit, Zenith Medical and Kidney Centre, Gudu, Abuja, Nigeria
| | - Ahmad Lawal
- Urology Division, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Kester Maduadi
- Radiology Department, Zenith Medical and Kidney Centre, Gudu, Abuja, Nigeria
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Renovascular heart failure: heart failure in patients with atherosclerotic renal artery disease. Cardiovasc Interv Ther 2016; 31:171-82. [PMID: 27052017 DOI: 10.1007/s12928-016-0392-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.
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Munnusamy K, Kasirajan SP, Gurusamy K, Raghunath G, Bolshetty SL, Chakrabarti S, Annadurai P, Miyajan ZB. Variations in Branching Pattern of Renal Artery in Kidney Donors Using CT Angiography. J Clin Diagn Res 2016; 10:AC01-3. [PMID: 27134847 DOI: 10.7860/jcdr/2016/16690.7342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/24/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Each kidney is supplied by a single renal artery originating from abdominal aorta. Since there are lots of renal surgeries happening now-a-days, it becomes mandatory for the surgeons to understand the abnormality and variations in the renal vasculature. AIM To study the variations in the branching pattern of renal artery for the presence of early division and accessory renal artery in Indian kidney donors using CT angiography. MATERIALS AND METHODS The CT angiogram images of 100 normal individuals willing for kidney donation were analysed for early divisions and occurrence of accessory renal artery. RESULTS A 51% of kidney donors showed variation in the renal artery. Out of 51% variations 38 individuals had accessory renal artery and 13 individuals had early division of renal artery. The distribution of accessory renal artery was equal on both sides (13% on right and left) and 12% of individuals had accessory renal artery on both sides. Out of 13% earlier divisions, 5% was on right side, 7% was on left side and 1% was on both sides. CONCLUSION This study concludes that 51% of kidney donors had renal artery variations. Hence, awareness of variations by evaluating the donors is a must before renal transplantation, urological procedures and angiographic interventions.
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Affiliation(s)
| | | | - Karthikeyan Gurusamy
- Assistant Professor, Department of Anatomy, Saveetha Medical College and Hospital , India
| | - Gunapriya Raghunath
- Professor, Department of Anatomy, Saveetha Medical College and Hospital , India
| | | | - Sudakshina Chakrabarti
- Assistant Professor, Department of Anatomy, Saveetha Medical College and Hospital , India
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M’rabet Bensalah K, Uehlinger D, Kalicki R, Czerwinska J. Hemodynamic Modeling of the Intrarenal Circulation. Ann Biomed Eng 2013; 41:2630-44. [DOI: 10.1007/s10439-013-0865-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
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Achieving renal denervation: catheter-based and surgical management for neural ablation in the management of hypertension. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 7:314-22. [PMID: 23274863 DOI: 10.1097/imi.0b013e31827ccd90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertension refractory to conventional management with medication remains a significant cause of cardiovascular morbidity and mortality. Alternative strategies are warranted in this subgroup of patients. The target of these strategies centers around sympathetic neural activity, which is thought to play a key role in hypertension. We will review the historic and current approaches toward altering sympathetic neural activity, specifically discussing surgical sympathectomy, catheter-based renal denervation strategies, and baroreflex activation therapy.
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Textor SC, Misra S, Oderich GS. Percutaneous revascularization for ischemic nephropathy: the past, present, and future. Kidney Int 2012; 83:28-40. [PMID: 23151953 PMCID: PMC3532568 DOI: 10.1038/ki.2012.363] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Occlusion of the renal arteries can threaten the viability of the kidney when severe, in addition to accelerating hypertension and circulatory congestion. Renal artery stenting procedures have evolved from a treatment mainly for renovascular hypertension to a maneuver capable of recovering threatened renal function in patients with “ischemic nephropathy” and improving management of congestive heart failure. Improved catheter design and techniques have reduced, but not eliminated hazards associated with renovascular stenting. Expanded use of endovascular stent grafts to treat abdominal aortic aneurysms has introduced a new indication for renal artery stenting to protect the renal circulation when grafts cross the origins of the renal arteries. Although controversial, prospective randomized trials to evaluate the added benefit of revascularization to current medical therapy for atherosclerotic renal artery stenosis until now have failed to identify major benefits regarding either renal function or blood pressure control. These studies have been limited by selection bias and have been harshly criticized. While studies of tissue oxygenation using blood oxygen level dependent (BOLD) MR establish that kidneys can adapt to reduced blood flow to some degree, more severe occlusive disease leads to cortical hypoxia associated with microvascular rarefication, inflammatory injury and fibrosis. Current research is directed toward identifying pathways of irreversible kidney injury due to vascular occlusion and to increase the potential for renal repair after restoring renal artery patency. The role of nephrologists likely will focus upon recognizing the limits of renal adaptation to vascular disease and identifying kidneys truly at risk for ischemic injury at a time point when renal revascularization can still be of benefit to recovering kidney function.
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Affiliation(s)
- Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
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Achieving Renal Denervation: Catheter-Based and Surgical Management for Neural Ablation in the Management of Hypertension. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Khosla A, Misra S, Greene EL, Pflueger A, Textor SC, Bjarnason H, McKusick MA. Clinical outcomes in patients with renal artery stenosis treated with stent placement with embolic protection compared with those treated with stent alone. Vasc Endovascular Surg 2012; 46:447-54. [PMID: 22692467 DOI: 10.1177/1538574412449911] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the clinical outcomes in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS) following renal artery (RA) stent placement with and without embolic protection device (EPD) usage. MATERIALS AND METHODS Eighteen patients who had RA stent placement with EPD were matched to control patients (RA stent only). Blood pressure, number of hypertensive medications, and estimated glomerular filtration rate (eGFR) at 3 months before the procedure and after 12 months were determined. An increase of ≥ 20% in eGFR at 12 months from baseline was defined as "improvement," decrease of ≥ 20% as "deterioration," and an eGFR change between those values as "stabilization" at 12 months. RESULTS At 12 months, stage 4 patients treated with EPD had significantly higher eGFR than controls (P = .01). There was no statistical difference in blood pressure outcomes between the 2 groups. CONCLUSIONS Patients with stage 4 CRI did significantly better with EPD than those treated without it.
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Affiliation(s)
- Ankaj Khosla
- Department of Radiology, School of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Holden A. Is There an Indication for Embolic Protection in Renal Artery Intervention? Tech Vasc Interv Radiol 2011; 14:95-100. [DOI: 10.1053/j.tvir.2011.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Renovascular diseases are common conditions with important implications on cardiovascular morbidity and mortality. Renal artery stenosis (RAS) is present in 1-5% of patients with hypertension (HTN) in the US with the vast majority of caused by atherosclerosis. Atherosclerotic RAS is related not only to uncontrolled HTN, but also to renal dysfunction. Atherosclerotic RAS in the USA has been reported to account for approximately 14-16% of new patients requiring dialysis each year. Hence a concerted effort was made in the last decade to treat renovascular stenosis using newly developed endovascular therapies to improve cardiovascular morbidity and renal function. A review on new advances in the endovascular management of renal artery stenosis with low profile stents, embolic protection devices, and drug eluting stents is presented.
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Carr TM, Sabri SS, Turba UC, Park AW, Saad WE, Angle JF, Matsumoto AH. Stenting for Atherosclerotic Renal Artery Stenosis. Tech Vasc Interv Radiol 2010; 13:134-45. [DOI: 10.1053/j.tvir.2010.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Geometric Variability of the Abdominal Aorta and Its Major Peripheral Branches. Ann Biomed Eng 2010; 38:824-40. [DOI: 10.1007/s10439-010-9925-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 01/07/2010] [Indexed: 10/20/2022]
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Use of kissing embolic protection devices in the treatment of early bifurcation renal artery stenosis: a case report. J Vasc Interv Radiol 2009; 20:1240-3. [PMID: 19616971 DOI: 10.1016/j.jvir.2009.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 05/19/2009] [Accepted: 05/20/2009] [Indexed: 11/20/2022] Open
Abstract
Renal artery stenosis (RAS) is a progressive disease that may cause hypertension and chronic renal insufficiency. Percutaneous renal artery angioplasty with stent placement is a well-recognized treatment for atherosclerotic RAS. It can infrequently involve the bifurcation, and treatment of this stenosis has been described using bare metal and drug-eluting stents deployed simultaneously in a kissing fashion. Atheroembolism is believed to be caused by the release of microscopic plaque fragments and cholesterol crystals from the RAS or atherosclerotic aorta. Herein, the authors describe the use of a kissing embolic protection device technique during renal artery stent placement.
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Turba UC, Uflacker R, Bozlar U, Hagspiel KD. Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women? Clin Anat 2009; 22:236-42. [PMID: 19172661 DOI: 10.1002/ca.20748] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured. Differences in measurements between genders were tested for statistical significance using analysis of variance (ANOVA) and Pearson's Chi-Square tests. A total of 798 renal arteries were available for analysis in 207 female (mean age = 52.91 years) and 192 male patients (mean age = 53.04 years). Female patients were found to have smaller aortae (at the level of the right renal ostium) and bilateral renal arteries than males (mean aortic diameter M/F = 18.33/15.89 mm, mean right renal artery ostial diameter M/F = 5.06/4.59 mm, mean left ostial renal diameter M/F = 5.14/4.66 mm) (p < .001). There was no statistical significance for the renal ostia level in relation to the vertebrae and the majority of renal arteries originated at the L1 and L2 levels. The longitudinal distance between right and left renal artery ostia ranged from 0 to 32 mm (mean = 4,6 mm, median = 5mm). The mean anteroposterior orientation of the right renal ostia was M/F = 29.45 degrees/28.20 degrees , and M/F = -7.96 degrees/-11.14 degrees for left renal artery ostia. The mean anteroposterior orientation of the right renal pedicle was M/F = 41.37 degrees/44.34 degrees and M/F = 42.31 degrees/43.95 degrees for the left pedicle. There are some differences in normal renal arterial anatomy between genders. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urologic procedures, but also for medical device development.
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Affiliation(s)
- Ulku Cenk Turba
- Department of Radiology, University of Virginia, Health System Foundation, Charlottesville, Virginia 22908, USA.
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Thatipelli MR, Misra S, Sanikommu SR, Schainfeld RM, Sharma SK, Soukas PA. Embolic protection device use in renal artery stent placement. J Vasc Interv Radiol 2009; 20:580-6. [PMID: 19328725 DOI: 10.1016/j.jvir.2009.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 01/09/2009] [Accepted: 01/11/2009] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of the present study was to report safety, efficacy, and renal function outcomes with use of the GuardWire embolic protection device (EPD) in renal artery stent placement for patients with renal artery stenosis (RAS) and chronic renal insufficiency (CRI). MATERIALS AND METHODS This was a retrospective study of all patients with RAS and CRI treated concomitantly with a GuardWire EPD and renal artery stents from December 2002 through June 2006. Renal function was determined by calculating the estimated glomerular filtration rate (eGFR) according to the Modification of Diet in Renal Disease formula, and subjects were divided into Kidney Disease Outcomes and Quality Initiative (K-DOQI) classes based on baseline eGFR. After revascularization, an improvement from baseline of at least one K-DOQI class was defined as improvement, unchanged K-DOQI class as stabilization, and worsening of at least one K-DOQI class as deterioration. RESULTS There were 63 patients (54% men) with a mean age of 75.2 years +/- 7.7. The mean baseline serum creatinine level and eGFR were 1.87 mg/dL +/- 0.6 (range, 1-3.8 mg/dL) and 36.63 mL/min per 1.73 m(2) +/- 11.42 (range, 13.85-59.99 mL/min per 1.73 m(2)), respectively, and at the last clinical follow-up, the respective measurements were 1.96 mg/dL +/- 0.72 and 38.75 mL/min per 1.73 m(2) +/- 13.25 (P = not significant). Over a mean follow-up period of 16 months +/- 12, 14 patients (25%) showed improvement, 33 (58%) had stable renal function, and 10 (18%) showed deterioration. There was one GuardWire-related dissection, which was successfully treated with a stent. CONCLUSIONS The GuardWire EPD, used during renal artery stent placement, is safe and was associated with stabilization or improvement in kidney function in 83% of patients with RAS and CRI.
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Misra S, Gomes MT, Mathew V, Barsness GW, Textor SC, Bjarnason H, McKusick MA. Embolic protection devices in patients with renal artery stenosis with chronic renal insufficiency: a clinical study. J Vasc Interv Radiol 2008; 19:1639-45. [PMID: 18789723 DOI: 10.1016/j.jvir.2008.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 07/23/2008] [Accepted: 08/03/2008] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To present clinical outcomes with the use of embolic protection devices (EPDs) and renal artery stents in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS). MATERIALS AND METHODS A retrospective study was conducted in 23 patients with RAS and CRI who were treated with renal artery stent placement with an EPD. Follow-up data were obtained through medical records. RESULTS In 23 patients (18 men; 78%) with an average age of 69.4 years +/- 11 (range, 46-86 y), 32 renal arteries were treated for worsening renal function (n = 17; 74%) or uncontrolled hypertension and worsening renal function (n = 6; 26%). Nine FilterWire EZ devices were used in eight patients (35%) and 17 SpideRX devices were used in 15 patients (65%). The average follow-up was 8 months +/- 5. After the stent procedure, the mean systolic blood pressure decreased significantly (P < .05) whereas the diastolic pressure remained unchanged. There was a significant increase in the mean estimated glomerular filtration rate from 32.9 mL/min +/- 12.9 at baseline to 41.3 mL/min +/- 13.7 at last follow-up (P < .05). In 96% of patients, there was improvement or stabilization of kidney function. In six of the 17 SpideRX devices (35%), macroscopically evident embolic material was observed in the device after stent placement. There were two minor and two major complications. CONCLUSIONS Renal artery stent placement combined with the use of a SpideRX or FilterWire EZ device is associated with an good clinical outcome with a reasonable safety profile.
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Affiliation(s)
- Sanjay Misra
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street Southwest, Alfred 6460, Rochester, MN 55902, USA.
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