[Retrograde renal phlebography with balloon occlusion of the renal artery. Technique and scope of a new method (author's transl)]

Demonstration of the renal venous system at routine nephroangiography. A comparison between metrizoate, metrizamide and ioxaglate

The demonstration of renal veins during routine nephroangiography was retrospectively investigated and blindly scored in 60 patients. Three different types of contrast media were used: one high-osmolar ionic monomeric (metrizoate) and two low-osmolar, the non-ionic monomeric (metrizamide) and the ionic monoacidic dimeric (ioxalate). The renal veins and the inferior vena cava were significantly better and more often demonstrated when ioxaglate was used compared with metrizoate and metrizmide. There was no significant difference between metrizoate and metrizamide. Following semiselective renal artery injection, the main renal veins were demonstrated with a diagnostically acceptable quality with ioxaglate in 76 per cent, with metrizamide in 40 per cent and with metrizoate in 29 per cent. On selective renal artery injection the demonstration of renal veins increased to 85 per cent with ioxaglate and remained unchanged with metrizmide (38%) and metrizoate (26%). Semiselective or selective nephroangiography with ioxaglate at an ordinary dose was in most patients sufficient to allow evaluation of renal vein involvement in disease, rendering high dose selective nephroangiography or selective nephrophlebography unnecessary. A slower diffusion rate of ioxaglate compared with metrizoate and metrizamide is considered to be the major explanation for the better demonstration of the renal veins.

Occlusion arteriography: diagnostic and therapeutic applicability of balloon catheters

Occlusion arteriography using flow-directed Swan-Ganz balloon catheters is a safe and simple method, which opens up new technical, diagnostic, and therapeutic possibilities. Since 1976, occlusion arteriography with double-lumen Swan-Ganz balloon catheters and a percutaneous introducer system has been performed in 315 patients. The following advantages were found: (1) simplification of selective and subselective catheterization due to the flow-directed positioning of the balloon-tipped catheter; (2) high contrast of the arterial phase of the angiogram and demonstration of the smallest arteries as a result of a brief, complete occlusion of the main vessels ("standstill arteriogram"); (3) early and optimal demonstration of the corresponding venous system, especially optimization of the indirect splenoportogram and mesentericoportogram; (4) reduction of the volume of contrast agent usually needed for diagnostic reasons; (5) reliable and complete blockade of the tumor-feeding artery during transcatheter embolization with particulate substances; (6) reliable and complete blockade of the feeding artery as a preoperative protective measure in tumor nephrectomy and splenectomy.

Renal venography: anatomy, technique, applications, analysis of 132 venograms, and a review of the literature

Selective renal venography is a simple but important diagnostic procedure which has few complications. A thorough knowledge of renal venous anatomy is essential for its proper performance and clinical application. This is particularly true because renal venous variations are frequent and may interfere with the successful appraoch to retroperitoneal surgery. The method is widely accepted for the evaluation of the renal venous bed in patients with suspected renal vein thrombosis or hematuria of unknown etiology. It depicts the extent of renal venous involvement in renal carcinoma and clarifies the diagnosis in some patients with avascular tumors, renal pelvic carcinoma, and retroperitoneal tumors. It may also be useful in defining the morphologic abnormality when the kidney fails to visualize on urography, in delineating the extent and nature of renal parenchymal disease, and in enhancing the precision of renal vein renin collection.

Renal occlusion phlebography: applicability of the balloon catheters

The technique of selective renal occlusion phlebography using Swan-Ganz or Dotter-Lucas balloon catheters is described. The Swan-Ganz catheter is introduced into the femoral vein with the aid of a Cordis introducer system. The Dotter-Lucas balloon catheter is inserted via the same route using a combination of either a Desilets-Hoffman or Edslab introducer, along with a Gebauer introducer. Occlusion of the renal vein is achieved by insufflation of the balloon with air or injection of saline or dilute contrast media into the balloon. Selective renal occlusion phlebography was performed in 116 patients in order to exclude renal vein thrombosis, to delineate poorly vascularized renal masses, to determine the venous involvement of a renal tumor, and to assess the patency of splenorenal shunts. Renal occlusion phlebography optimizes the retrograde opacification of the renal veins. It has value in the delineation of poorly vascularized renal masses and in the determination of the venous involvement of renal and retroperitoneal tumors, and it would seem to be the method of choice for demonstrating the patency of surgical splenorenal shunts. Further enhancement of venous opacification by the combination of temporary arterial vasoconstriction with angiotensin (pharmaco-occlusion phlebography) and venous balloon occlusion is useful in some cases.

Simultaneous balloon occlusion of the renal artery and hypothermic perfusion in in situ surgery of the kidney

Renal ischemia and cooling may be achieved by intraluminal balloon occlusion and intermittent hypothermic perfusion using a double lumen, balloon-tipped catheter introduced into the renal artery percutaneously. This technique was used successfully in 26 of 31 extensive nephrolithotomies, eliminating the need for dissection and clamping of the renal artery and intricate surface cooling. Intrarenal operations could be performed as effectively as with clamp occlusion. Despite a mean ischemia time of 54 minutes the individual 131I-hippuran clearance of the operated kidneys was only reduced to a mean 78.4 per cent of the preoperative value 2 to 3 weeks postoperatively and increased to 92.2 per cent after 3 to 6 months, with a tendency toward further improvement.