1
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Kersjes W, Bengel A, Jurczok A. [Treatment of Renal Artery Perforation with Covered Stent after Percutaneous Biopsy of Pancreatic Head]. Dtsch Med Wochenschr 2021; 146:759-762. [PMID: 34062594 DOI: 10.1055/a-1427-8892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND CLINICAL FINDING In a 67-year-old female patient with upper abdominal pain, computed tomography showed a partly calcified swelling of the pancreatic head and wall thickening of the duodenum. EXAMINATIONS Inpatient physical examination findings were normal. Laboratory showed increased pancreatic enzymes (amylase 210 U/l [Standard range: 28-100 U/l], lipase 2115 U/l [Standard range: 23-300 U/l]) and inflammation values (CRP 11.7 mg/l [Standard range: < 5.0 mg/l]), otherwise largely normal laboratory parameters. In the esophago-gastro-duodenoscopy, biopsy of swollen, partly stenosing mucous membrane areas in the duodenum was performed. DIAGNOSIS Histology revealed partial erosive duodenitis, no evidence of a malignant tumor. If chronic calcifying pancreatitis was suspected, a sonographically guided percutaneous biopsy of the pancreatic head was performed to exclude a tumor. TREATMENT AND COURSE Post-biopsy, the patient developed abdominal pain and temporary circulatory instability with nausea/vomiting and a drop in Hb to 7.5 g/dl [Standard range: 12.3-15.3 g/dl]. The sonographic suspicion of a retroperitoneal hematoma was confirmed by computed tomography. The cause was a haemorrhage from a renal artery perforation on the right side, which could be stopped by immediate angiographic intervention with a covered stent. CONCLUSION After percutaneous biopsy, vascular perforation must always be considered. Computed tomography provides a reliable and quick diagnosis. Minimally invasive percutaneous insertion of a covered stent is the therapy of choice in the case of a renal artery accessible to stents.
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Affiliation(s)
- Wilhelm Kersjes
- Institut für Diagnostische und Interventionelle Radiologie, RKH Klinikum Ludwigsburg
| | - Andreas Bengel
- Institut für Diagnostische und Interventionelle Radiologie, RKH Klinikum Ludwigsburg
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2
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Zhang H, Jia B, Zeng L, Xiao Z, Shen J, Qian H, Zhang E, Hu J. Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report. BMC Surg 2018; 18:100. [PMID: 30445948 PMCID: PMC6240213 DOI: 10.1186/s12893-018-0440-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Thoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. We presented two cases of unexpected RH after TEVAR for complicated type B aortic dissection, and the potential causes, diagnosis and therapeutic management were discussed. Case presentation A 67-year-old female developed hypotension and progressively decrease of hemoglobin within 5 h after TEVAR for acute complicated type B dissection. Bedside ultrasonography and abdominal computed tomography angiography revealed a massive right perinephric hematoma. The right renal angiography detected multiple tortuous vascular branches with diffuse perinephric bleeding. The main trunk of right renal artery was embolized. The patient recovered uneventfully and presented with normal renal function 6 months later. Another patient was a 69-year-old male who was admitted for endovascular repair of a chronic complicated type B aortic dissection. The patient presented with hemodynamic instability early after TEVAR. Bedside ultrasonography showed a giant left retroperitoneal hematoma. The abdominal angiography revealed two active bleeding sits located in the distal branches of left renal artery. A super-selective embolization of the two arteries was performed, however the patient developed abdominal compartment syndrome and died of multiple organ failure. Conclusions Unexpected RH after endovascular repair of aortic dissection might be associated with iatrogenic and idiopathic factors. Close surveillance and clinician’s awareness of this rare complication is crucial for accurate and prompt diagnosis. Renal angiography and subsequent selective embolization of bleeding vessels are effective interventions for treating this fatal condition. Electronic supplementary material The online version of this article (10.1186/s12893-018-0440-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongwei Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bangsheng Jia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ling Zeng
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jiayu Shen
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Eryong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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3
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Zeller T, Frank U, Müller C, Bürgelin K, Schwarzwälder U, Sinn L, Horn B, Roskamm H, Neumann FJ. Technological Advances in the Design of Catheters and Devices Used in Renal Artery Interventions: Impact on Complications. J Endovasc Ther 2016; 10:1006-14. [PMID: 14656167 DOI: 10.1177/152660280301000526] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To analyze the impact of technical improvements in stent devices and guiding catheters (e.g., reduced device diameter, increased flexibility) on the complication rates associated with percutaneous renal artery interventions. Methods: During a 5-year period (1997–2001), 268 consecutive patients (178 men; mean age 67±9 years) had 370 atherosclerotic renal artery stenoses (RAS) ≥70% treated with angioplasty/stenting in 320 procedures. The guiding catheter technique was used routinely until 2000; in 2001, a guiding sheath was used in 29% of cases. From 1997 to 2000, sealing devices were frequently used for sheath removal; during the last year, the sheaths were removed using the Femostop device. Results: In 320 interventions, 32 (10%) complications occurred, with a decreasing frequency during the last 2 years (1996/97: 13% [7/53]; 1998: 16% [9/57]; 1999: 15% [11/74]; 2000: 4% [3/70]; 2001: 3% [2/66]). There were 21 (6.6%) local complications, including 4 cases requiring permanent hemodialysis after the intervention and 11 (3.4%) access site complications. No procedure-related death occurred. During the study period, the average sheath diameter was reduced from 8.15±0.76 F to 6.15±0.63 F (p<0.05). Mean procedural time was reduced from 42±13 minutes to 23±11 minutes (p<0.05). The initial heparin dose was reduced from 10,000 to 5000 units. Conclusions: In parallel with the use of more flexible catheters and premounted stents of lower profile, the complication rate of renal angioplasty/stenting of atherosclerotic RAS has been reduced significantly during a 5-year period.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Germany.
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4
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Ierardi AM, Floridi C, Fontana F, Duka E, Pinto A, Petrillo M, Kehagias E, Tsetis D, Brunese L, Carrafiello G. Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol Med 2013; 119:261-8. [PMID: 24297586 DOI: 10.1007/s11547-013-0343-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 03/18/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of our study was to review our experience and long-term follow-up in the treatment of iatrogenic renal vascular injuries using transcatheter embolisation. MATERIALS AND METHODS Our retrospective analysis of cases collected in two interventional centres consists of a total of 21 patients who underwent renal arterial embolisation (RAE) for iatrogenic arterial kidney bleeding. Biopsy (n = 4), percutaneous nephrolithotomy (n = 4), nephron-sparing surgery (n = 4), guidewire-induced arterial perforation during coronary angiography or renal stenting (n = 3), percutaneous nephrostomy (n = 3), renal endopyelotomy/pyeloplasty (n = 2) and surgical nephrectomy were the iatrogenic causes. Seven patients presented with haemodynamic instability requiring blood transfusion (33.3%), the remaining were haemodynamically stable (66.7%). Diagnostic renal angiography revealed 9 actively bleeding vessels, 6 pseudoaneurysms, 4 arteriovenous fistulas and 1 arterio-calyceal fistula. In one patient selective renal arteriography was negative probably because the bleeding observed at CT angiography was self-limited. Twenty-one embolisation procedures were performed in 20 patients; one patient required a second embolisation 3 h after the first one. Embolisation was performed with microcoils, polyvinyl alcohol particles, embospheres, spongostan emulsion and vascular plug. RESULTS The technical success rate was 100%. The overall clinical success rate was 95%. Apart from a patient who died due to disseminated intravascular coagulation, no major complications requiring intensive care treatment were encountered during or after the procedures. No patient required emergency surgery or subsequent surgical treatment. No statistically significant differences in eGFR or renal function stage appeared after RAE. CONCLUSIONS Percutaneous treatment can be proposed as a first-line treatment in iatrogenic renal arterial injuries, resulting in a safe and effective procedure.
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Affiliation(s)
- Anna Maria Ierardi
- Interventional Radiology, Department of Radiology, Insubria University, Viale Borri 57, 21100, Varese, Italy
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5
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Liu GJ, Wang YF, Liu ZG, Zhang LP, Wang ZJ, Luo J, Zeng YJ. Perirenal hemorrhage secondary to interventional radiology operation against head and neck vessels: two cases report and review of the literature. Int J Neurosci 2012; 123:347-52. [PMID: 23240577 DOI: 10.3109/00207454.2012.758122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to the hidden hemorrhage and a lack of specificity in its manifestations, perirenal hemorrhage as a complication of interventional radiology procedures is not always diagnosed in a timely manner; furthermore, the cause of hemorrhage is often misidentified or uncertain. In this report, two cases of elderly male patients who each had a perirenal hemorrhage on the same side after an interventional radiology operation against head and neck vessels by the same operator on the same day are described. This study demonstrated that the perirenal hemorrhages in both patients were related to the interventional radiology operations, providing a reminder that operating gently and always keeping the guide wire in sight during the insertion are critical for reducing the incidence rate of perirenal hemorrhage.
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Affiliation(s)
- Guang Jian Liu
- Department of Neurology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan City, Hubei Province, China
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6
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Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N. EAU Guidelines on Iatrogenic Trauma. Eur Urol 2012; 62:628-39. [DOI: 10.1016/j.eururo.2012.05.058] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/28/2012] [Indexed: 11/29/2022]
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7
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Renal artery perforation related with hydrophilic guide wire during coronary intervention: successful treatment with polyvinyl alcohol injection. Can J Cardiol 2012; 28:612.e5-7. [PMID: 22575577 DOI: 10.1016/j.cjca.2012.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/29/2012] [Accepted: 03/12/2012] [Indexed: 11/23/2022] Open
Abstract
Hydrophilic guide wire-related renal artery perforation (RAP) and subsequent retroperitoneal hemorrhage (RPH) during coronary angiography (CAG) is very rare. We present the case of a 68-year-old woman who suffered accidental hydrophilic 0.035-inch guide wire piercing-related RAP and RPH during CAG and coronary intervention. This RAP was diagnosed by bedside ultrasonography and selective renal angiography, and was successfully treated by transcatheter polyvinyl alcohol injection.
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8
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Pipili C, Grapsa E, Arapoglou V, Tzanatos H. Successful non-surgical treatment of perirenal haematoma after percutaneous renal artery angioplasty in a solitary kidney. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2012; 46:133-135. [PMID: 22150780 DOI: 10.3109/00365599.2011.638933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Renal artery angioplasty with stent placement represents an effective choice for correcting renal artery stenosis. However, if iatrogenic renal artery injury occurs, as in the case of solitary kidney, the risk of requiring chronic dialysis increases. This article reports the case of a patient with a solitary kidney, who underwent renal stenting and developed a retroperitoneal haematoma. The patient was managed conservatively and the perirenal haematoma resolved. Within the period of follow-up, the patient had maintained stable renal function with adequate blood pressure control.
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Affiliation(s)
- Chrysoula Pipili
- Department of Nephrology, Aretaieion University Hospital, Athens, Greece.
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9
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Reply to the Article Entitled “Emergency Renal Ablation for Life-Threatening Hemorrhage from Multiple Capsular Branches During Renal Artery Stenting” by Aytekin et al. Cardiovasc Intervent Radiol 2010; 34:655-6; author reply 654. [DOI: 10.1007/s00270-010-9993-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Aytekin C, Yıldırım UM, Ozyer U, Harman A, Boyvat F. Emergency Renal Ablation for Life-Threatening Hemorrhage from Multiple Capsular Branches During Renal Artery Stenting. Cardiovasc Intervent Radiol 2009; 33:663-6. [DOI: 10.1007/s00270-009-9760-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Favero L, Saccà S, Cernetti C, Pasquetto G, Nikas D, Reimers B. Superselective embolization of renal hemorrhage occurring after percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2009; 10:62-5. [PMID: 19159859 DOI: 10.1016/j.carrev.2007.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 11/29/2007] [Indexed: 10/21/2022]
Abstract
A 69-year-old female was hospitalized for acute coronary syndrome and received full antiplatelet and anticoagulant therapy. The patient underwent angioplasty and stent implantation on right coronary and left circumflex arteries with good angiographic result. After the procedure, the patient developed hemorrhagic shock due to massive left renal hemorrhage. An emergent digital subtraction angiography showed bleeding from a left segmental renal artery. The hemorrhage was successfully managed with transcatheter superselective embolization. The patient was discharged after 22 days in good general condition with normal renal function. One-year follow-up was uneventful.
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Affiliation(s)
- Luca Favero
- Department of Cardiology, Mirano Hospital, Mirano, Italy.
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12
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Affiliation(s)
- Sinan Sahin
- Radiology Department, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
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13
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Rami P, Williams D, Forauer A, Cwikiel W. Stent-Graft Treatment of Patients with Acute Bleeding from Hepatic Artery Branches. Cardiovasc Intervent Radiol 2005; 28:153-8. [PMID: 15696351 DOI: 10.1007/s00270-004-0056-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To present a new treatment option in patients with acute bleeding from the hepatic artery branches. METHODS Four male patients, 23-49 years old (mean 36.3 years), were treated for acute bleeding and subsequent transient hypotension. Bleeding episodes were secondary to hepatic artery pseudoaneurysms in two patients and surgical suture insufficiency in one patient. In the remaining patient, anastomotic leakage occurred following thrombolysis for hepatic artery thrombosis. Patients were treated by endovascular placement of one or two balloon-expandable stent-grafts, ranging from 17 to 28 mm in length. RESULTS All procedures were carried out without serious complications. All stent-grafts were deployed in the intended position with immediate cessation of bleeding and initial preservation of satisfactory blood flow. CONCLUSIONS Bleeding from the hepatic artery can be treated by insertion of balloon-expandable stent-grafts in the acute setting.
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Affiliation(s)
- Parag Rami
- Department of Radiology, University of Michigan Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0030, USA
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14
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Horwitz MD, Hanbury DC, King CM. Renal artery pseudoaneurysm following partial nephrectomy treated with stent-graft. Br J Radiol 2005; 78:161-3. [PMID: 15681331 DOI: 10.1259/bjr/68507140] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Haemorrhagic complications due to pseudoaneurysms of branch arteries can be treated by selective embolisation. Injuries to the main renal artery cannot be treated in this way without sacrificing the kidney. We report the successful percutaneous treatment of a main renal artery pseudoaneurysm with a stent-graft in a patient with a solitary kidney.
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Affiliation(s)
- M D Horwitz
- Department of Urology, Lister Hospital, Stevenage, Hertfordshire SG1 4AB, UK
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15
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Axelrod DJ, Freeman H, Pukin L, Guller J, Mitty HA. Guide wire perforation leading to fatal perirenal hemorrhage from transcortical collaterals after renal artery stent placement. J Vasc Interv Radiol 2004; 15:985-7. [PMID: 15361567 DOI: 10.1097/01.rvi.0000130861.14338.12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
After successful renal artery angioplasty and stent placement, a patient in a fully anticoagulated state developed hypotension and flank pain. Review of the intraprocedural angiogram demonstrated transcortical position of the guide wire. Computed tomography of the abdomen revealed a large perinephric hematoma. Although only a single renal artery branch was accessed with the guide wire during stent placement, subsequent emergent angiography revealed extravasation from multiple capsular branches. Renal artery embolization failed to control the hemorrhage. The patient's course rapidly deteriorated and he ultimately died. The unique angiographic finding and proposed mechanism of this fatal complication are described and discussed.
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Affiliation(s)
- David J Axelrod
- Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai School of Medicine, Box 1234, 1 Gustave L. Levy Place, New York, NY 10029, USA
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16
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Heye S, Vanbeckevoort D, Blockmans D, Nevelsteen A, Maleux G. Iatrogenic Main Renal Artery Injury: Treatment by Endovascular Stent-Graft Placement. Cardiovasc Intervent Radiol 2004; 28:93-4. [PMID: 15602634 DOI: 10.1007/s00270-004-0050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on a patient who presented with perforation of the left main renal artery as a complication of a percutaneous retroperitoneal drainage procedure. Only a small number of cases of iatrogenic main renal artery perforations have been reported, none of them due to a percutaneous drainage attempt. Endovascular treatment by means of a coronary stent-graft was successful.
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Affiliation(s)
- Sam Heye
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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17
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Haesemeyer SW, Vedantham S, Braverman A. Renal Artery Stent Placement Complicated by Development of a Type B Aortic Dissection. Cardiovasc Intervent Radiol 2004; 28:98-101. [PMID: 15772726 DOI: 10.1007/s00270-004-0049-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Percutaneous renal artery angioplasty and stent placement have demonstrated safety and effectiveness in the treatment of selected patients with renovascular hypertension and ischemic nephropathy. Major complications have been predominantly confined to the affected renal artery and kidneys, including renal artery dissection and/or thrombosis, distal embolization, and contrast-related nephropathy. We report a case in which treatment of an ostial renal artery lesion with placement of a balloon-expandable stent was complicated by the development of an acute Type B aortic dissection.
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Affiliation(s)
- Scott W Haesemeyer
- The Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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18
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Di Valentino M, Alerci M, Tutta P, Sartori F, Marone C, Vandoni R, Mahler F, Gallino A. Thrombus aspiration as a bailout procedure during percutaneous renal angioplasty. J Endovasc Ther 2004; 11:522-6. [PMID: 15298510 DOI: 10.1583/03-1196.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To present a case in which thrombus aspiration, urokinase, and abciximab were used to recanalize a sudden acute thrombotic occlusion of the right renal artery during percutaneous renal angioplasty. CASE REPORT A 72-year-old man with severe arterial hypertension, impaired renal function, and peripheral artery disease was referred for interventional renal revascularization of a proximal stenosis of the right renal artery. Predilation was unsuccessful, and stent placement was followed by immediate occlusion of the distal renal artery, probably due to dislocation of a mural thrombus. Since intra-arterial administration of urokinase (300,000 IU) was ineffective, thrombus aspiration was performed using the 7-F guiding catheter. After successful removal of the thrombus, abciximab was given intravenously. Control angiograms showed recanalization of the stented segment and patency of the distal renal arteries, an outcome confirmed 8 months later by duplex ultrasound. CONCLUSIONS As demonstrated in our case, thromboembolic complications can be rapidly and successfully treated on the table by combined measures, such as catheter thrombus extraction and pharmacological strategies.
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19
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Carlos RC, Axelrod DA, Ellis JH, Abrahamse PH, Fendrick AM. Incorporating patient-centered outcomes in the analysis of cost-effectiveness: imaging strategies for renovascular hypertension. AJR Am J Roentgenol 2004; 181:1653-61. [PMID: 14627591 DOI: 10.2214/ajr.181.6.1811653] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Our aim was to assess the contribution of patient-centered short-term disutilities and quality-of-life measures in the cost-effectiveness analysis of CT angiography, MR angiography, and conventional angiography in patients with medication-resistant hypertension. MATERIALS AND METHODS A decision analytic model compared the life expectancy and incremental cost per life year using three initial diagnostic tests in a cohort of hypothetical individuals with medication-resistant hypertension over a range of renal artery stenosis probabilities: CT angiography (sensitivity, 96%; specificity, 96%; cost, $865); MR angiography (98%, 94%, $850); and conventional angiography (99%, 99%, $2,627). All imaging strategies were compared with a base case scenario mimicking the natural history of medication-resistant hypertension and with a scenario immediate enhanced medical therapy without prior imaging. Individuals without evidence of renal artery stenosis on initial testing underwent conventional angiography if enhanced medical therapy failed to control hypertension. Individuals diagnosed with renal artery stenosis on MR angiography required conventional angiography for definitive stent treatment ($11,1223). Blood pressure response to renal artery stenting or enhanced medical therapy varied according to blood pressure, as did the incidence of myocardial infarction and stroke resulting from hypertension. Patients who progressed to end-stage renal disease received dialysis ($60,000 per year). Quality-of-life adjustments were made for patients with hypertension, end-stage renal disease, myocardial infarction, and stroke. Short-term disutilities from undergoing an imaging test were included. The analysis accounted for direct costs derived from Medicare reimbursements and total costs derived from the literature. RESULTS All imaging strategies were cost-effective compared with enhanced medical therapy alone or with natural history. When only direct costs were considered, MR angiography was the preferred strategy, with conventional angiography as a cost-effective alternative to MR angiography. When total costs were considered, conventional angiography dominated all other strategies. Adjusting for quality of life decreased the incremental cost-effectiveness ratios, making an already competitive strategy a more favorable alternative to the base case. Adjusting for test-related disutility did not significantly influence the cost-effectiveness of any of the imaging tests. Despite marked variation in the key clinical and cost variables, MR angiography remained the most cost-effective strategy. CONCLUSION In the evaluation and treatment of medication-resistant hypertension, strategies that included preliminary imaging saved more lives than did the immediate institution of enhanced medical therapy at a lesser cost.
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Affiliation(s)
- Ruth C Carlos
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030, USA
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20
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Zeller T, Frank U, Müller C, Bürgelin K, Schwarzwälder U, Sinn L, Horn B, Roskamm H, Neumann FJ. Technological Advances in the Design of Catheters and Devices Used in Renal Artery Interventions: Impact on Complications. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<1006:taitdo>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Ahn JY, Chung YS, Lee BH, Kim OJ. Endovascular rescue from arterial rupture and thrombosis during middle cerebral artery stenting. Neuroradiology 2003; 45:570-3. [PMID: 12844201 DOI: 10.1007/s00234-003-1030-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 04/21/2003] [Indexed: 11/28/2022]
Abstract
Intravascular stents are being used with increasing frequency in interventional neuroradiology. Iatrogenic arterial rupture is an uncommon but serious complication. We present a case of arterial rupture and subarachnoid haemorrhage during middle cerebral artery stenting, treated by emergency additional, overlapping stenting and balloon tamponade of the dissected vessel. Thrombotic occlusion of the artery was managed by intra-arterial abciximab. Normal vessel patency was re-established within 20 min and the patient recovered with no neurological deficit.
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Affiliation(s)
- J Y Ahn
- Department of Neurosurgery, College of Medicine, Pundang CHA Hospital, 351 Yatap-ding, Pundang-gu, 463-712 Sungnam, South Korea.
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22
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Tyagi S, Rangesetty UC, Kaul UA. Endovascular treatment of aortic rupture during angioplasty for aortic in-stent restenosis in aortoarteritis. Catheter Cardiovasc Interv 2003; 58:103-6. [PMID: 12508209 DOI: 10.1002/ccd.10396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortic rupture during balloon angioplasty for in-stent restenosis without attempting to overexpand it is a rarity. We report a case of a young woman with aortoarteritis who had aortic rupture during angioplasty for in-stent restenosis. The balloon used was of the same diameter as the previously implanted stent and was completely within the stent during inflation. The disruption was successfully treated by percutaneous placement of a self-expandable endovascular stent graft.
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Affiliation(s)
- Sanjay Tyagi
- Department of Cardiology, G B Pant Hospital, New Delhi, India.
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Cejna M, Virmani R, Jones R, Bergmeister H, Loewe C, Schoder M, Grgurin M, Lammer J. Biocompatibility and performance of the Wallstent and the Wallgraft, Jostent, and Hemobahn stent-grafts in a sheep model. J Vasc Interv Radiol 2002; 13:823-30. [PMID: 12171986 DOI: 10.1016/s1051-0443(07)61992-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Three recently developed stent-grafts and the Wallstent were compared directly in an ovine animal model with regard to performance and biocompatibility. MATERIALS AND METHODS Three stent-grafts, the Hemobahn (polytetrafluoroethylene [ePTFE]/nitinol), Wallgraft (polyester/Ni-Co-Ti-steel alloy), and Jostent peripheral stent-graft (balloon-expandable ePTFE/stainless steel), and the Wallstent (Ni-Co-Ti-steel alloy), were implanted in sheep iliac arteries (one type of each stent or stent-graft per animal, n = 8). Pre- and postimplantation luminal diameters were measured for each prosthesis and implantation site. Angiography, intravascular ultrasonography (IVUS), and histomorphometric, histologic, and scanning electron microscopic analyses were performed at 3 months. RESULTS Early lumen gain, late lumen loss, and patent vessel diameter at angiography were not significantly different. Two stent-grafts had significantly more neointima formation (Hemobahn, 9.88 mm(2) +/- 0.94; Wallgraft, 14.98 mm(2) +/- 0.90) than the other stent-graft (Jostent, 6.52 mm(2) +/- 0.46) and the Wallstent (5.24 mm(2) +/- 0.62; P <.01). Patent lumen area was not significantly different (Hemobahn, 42.57 mm(2) +/- 1.41; Jostent, 39.76 mm(2) +/- 2.04; Wallgraft, 40.22 mm(2) +/- 1.04; Wallstent, 41.64 mm(2) +/- 1.59; P =.57). The Hemobahn had significantly more inflammatory reaction (inflammation score of 0.83 +/- 0.03) than the Jostent (0.58 +/- 0.03), Wallgraft (0.55 +/- 0.04), or Wallstent (0.16 +/- 0.01). Angiography and IVUS demonstrated absence of anastomotic neointima formation. Endothelialization was incomplete and immature for all prostheses. CONCLUSIONS The stent-grafts caused a greater degree of neointima formation and inflammatory vessel wall reaction than the bare stent. However, these changes did not interfere with patent lumen areas and occurred in the absence of excessive anastomotic neointima formation.
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Affiliation(s)
- Manfred Cejna
- Department of Radiology, University of Vienna, Austria.
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