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Thebridge L, Fisher C, Puttaswamy V, Pollock C, Clarke J. Systematic review of intra-operative duplex scanning during renal transplantation. Australas J Ultrasound Med 2022; 25:42-50. [PMID: 35251902 PMCID: PMC8873620 DOI: 10.1002/ajum.12289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION A systematic review of the value of intra-operative duplex scanning during renal transplantation was undertaken. METHODS Studies assessing intra-operative renal cortical flow in the arcuate vessels with outcomes of ultrasound directed interventions during the initial procedure, delayed graft function, post-operative resistive indices, graft losses and early returns to theatre for graft hypoperfusion were reviewed. PROSPERO registration: (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203873). RESULTS Literature searching identified 2069 articles for screening, with 131 reviewed and 12 selected for analysis comprising 5 individual case reports, one case series of 11 patients and 6 non-randomised controlled trials. Studies with similar methodologies were pooled because of the low number of studies and outcomes. Outcomes of interest were not reported for all patients. Intra-operative interventions comprising graft repositioning in 18 (16%) and vascular revision in 2 (2%) were performed in 115 patients undergoing intra-operative scans. There were no graft losses or returns to theatre for graft hypoperfusion (0 of 108 cases) compared to 7 of 71 (10%) without intraoperative scanning (P = 0.003). Three of 8 (38%) patients with high intra-operative resistive indices (RIs) were returned to theatre for hypoperfusion compared to 1 of 110 (1%) patients with normal resistive indices (P = <0.001). Ten of 13 (77%) patients with high RIs had delayed graft function compared to 10 of 40 (25%) with normal RIs (P = 0.001). CONCLUSION Despite the absence of randomised controlled trials, and heterogeneous small studies, adverse outcomes were reduced with intra-operative scanning. High intraoperative RIs were predictive of both delayed graft function and return to theatre for hypoperfusion.
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Affiliation(s)
- Linda Thebridge
- Department of Vascular SurgeryRoyal North HospitalSt LeonardsNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South Wales2006Australia
| | - Charles Fisher
- Department of Vascular SurgeryRoyal North HospitalSt LeonardsNew South WalesAustralia
| | - Vikram Puttaswamy
- Department of Vascular SurgeryRoyal North HospitalSt LeonardsNew South WalesAustralia
| | - Carol Pollock
- Department of Vascular SurgeryRoyal North HospitalSt LeonardsNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South Wales2006Australia
| | - Jillian Clarke
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South Wales2006Australia
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Lubner MG, Mankowski Gettle L, Kim DH, Ziemlewicz TJ, Dahiya N, Pickhardt P. Diagnostic and procedural intraoperative ultrasound: technique, tips and tricks for optimizing results. Br J Radiol 2021; 94:20201406. [PMID: 33684305 DOI: 10.1259/bjr.20201406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Intraoperative ultrasound (IOUS) is a valuable adjunctive tool that can provide real-time diagnostic information in surgery that has the potential to alter patient management and decrease complications. Lesion localization, characterization and staging can be performed, as well as surveying for additional lesions and metastatic disease. IOUS is commonly used in the liver for hepatic metastatic disease and hepatocellular carcinoma, in the pancreas for neuroendocrine tumors, and in the kidney for renal cell carcinoma. IOUS allows real-time evaluation of vascular patency and perfusion in organ transplantation and allows for early intervention for anastomotic complications. It can also be used to guide intraoperative procedures such as biopsy, fiducial placement, radiation, or ablation. A variety of adjuncts including microbubble contrast and elastography may provide additional information at IOUS. It is important for the radiologist to be familiar with the available equipment, common clinical indications, technique, relevant anatomy and intraoperative imaging appearance to optimize performance of this valuable imaging modality.
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Affiliation(s)
- Meghan G Lubner
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - David H Kim
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Perry Pickhardt
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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3
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Bejic M, Déglise S, Venetz JP, Nseir G, Dubuis C, Saucy F, Berard X, Meuwly JY, Corpataux JM. Use of Intraoperative Duplex Ultrasound and Resistance Index Reduces Complications in Living Renal Donor Transplantation. Transplant Proc 2018; 50:3192-3198. [PMID: 30577184 DOI: 10.1016/j.transproceed.2018.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/05/2018] [Accepted: 08/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of choice in end-stage renal disease is transplantation. Hemodynamic disturbances can evoke graft loss, while early ultrasound identification of vascular problems improves outcome. The aim of this study was to identify differences in postoperative complications with and without systematic intraoperative Doppler ultrasound use. METHODS The primary outcome was the postoperative rate of complications and the secondary aim was to find a predictive resistance index cut-off value, which would show where surgical reintervention was necessary. Over a 10-year period, 108 renal transplants were performed from living donors at our institution. In group 1 (n = 67), intraoperative duplex ultrasound and intraparenchymatous resistance index measurements assessed patients, while in group 2 (n = 41), no ultrasound was performed. RESULTS There were no intergroup differences in the overall postoperative complication rate or in benefit to graft or patient survival with Doppler use. However, significantly more vascular complications (10% vs 0%, P = .02) and more acute rejections (37% vs 10%) occurred in group 2 than in group 1. Therefore, an intraoperative cut-off value of the resistance index 0.5 was proposed to justify immediate surgical revision. CONCLUSIONS This is the first report demonstrating benefits of systematic intraoperative Doppler ultrasound on postoperative complications in renal transplantation from living donors. Our results support surgical revision with a resistance index <0.5.
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Affiliation(s)
- M Bejic
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - S Déglise
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland.
| | - J P Venetz
- Center of Organ Transplantation, University Hospital (CHUV), Lausanne, Switzerland
| | - G Nseir
- Center of Organ Transplantation, University Hospital (CHUV), Lausanne, Switzerland
| | - C Dubuis
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - F Saucy
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - X Berard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - J Y Meuwly
- Department of Radiology, University Hospital (CHUV), Lausanne, Switzerland
| | - J M Corpataux
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
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Lamby P, Jung F, Falter J, Mrowietz C, Graf S, Schellenberg L, Platz Batista da Silva N, Prantl L, Franke RP, Jung EM. Effect of radiographic contrast media on renal perfusion - First results. Clin Hemorheol Microcirc 2017; 64:287-295. [PMID: 28128758 DOI: 10.3233/ch-168110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intra-arterial administration of radiographic contrast media (CM) is discussed to impair renal perfusion. The pathogenesis of contrast-induced Nephropathy (CIN) is still not clarified. OBJECTIVE This trial was performed to prove the effects of two CM with different molecular structure on renal perfusion. METHODS A prospective, randomized study on 16 pigs was designed to compare the outcome after application of a low-osmolar iodinated CM (770 mOsm/kg H2O - Group1) and an iso-osmolar iodinated CM (290 mOsm/kg H2o - Group2).Color Coded Doppler Sonography (LOGIQ E9, GE, Milwaukee, USA) was applied for measuring the Renal Resistive Index (RRI) before and after the first, fifth, and tenth bolus of CM. Statistics was performed using analysis of variance for repeated measurements with the Factor "CM". RESULTS All flow spectra were documented free of artifacts and Peak Systolic Velocity (PSV), Enddiastolic Velocity (EDV) and RRI respectively could be calculated. Mean PSV in Group 1 led to a decrease while in Group 2 PSV showed a significant increase after CM (p = 0,042). The course of the mean EDV in both groups deferred accordingly (p = 0,033). Mean RRI over time significantly deferred in both groups (p = 0,001). It showed a biphasic course in Group 2 and a decrease over time in Group 2. CONCLUSION While iso-osmolar CM induced an increase of PSV and EDV together with a decrease of RRI, low-osmolar CM could not show this effect or rather led to the opposite.
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Affiliation(s)
- P Lamby
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - J Falter
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C Mrowietz
- Institute for Heart and Circulation Research, Eißendorfer Pferdeweg, Hamburg-Harburg, Germany
| | - S Graf
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Schellenberg
- Department of Anesthesiology, University of Regensburg, Regensburg, Germany
| | | | - L Prantl
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - R P Franke
- Department of Biomaterials, Central Institute for Biomedical Engineering, University of Ulm, Ulm, Germany
| | - E M Jung
- Department of Anesthesiology, University of Regensburg, Regensburg, Germany
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Penna FJ, Harvey E, John P, Armstrong D, Luginbuehl I, Odeh RI, Alyami F, Koyle MA, Lorenzo AJ. Intra-arterial nitroglycerin for intra-operative arterial vasospasm during pediatric renal transplantation. Pediatr Transplant 2016; 20:463-6. [PMID: 26899590 DOI: 10.1111/petr.12688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
Intra-operative arterial vasospasm during pediatric renal transplantation is an urgent clinical situation resulting in end-organ ischemia, associated changes in parenchymal turgor and color, diminished flow on ultrasound, and if left untreated, allograft loss. We hypothesized that intra-operative intra-arterial injection of nitroglycerin would reverse vasospasm and improve renal perfusion. A three-yr-old girl with end-stage renal disease due to autosomal recessive polycystic kidney disease on peritoneal dialysis underwent deceased donor renal transplantation. After optimal immediate reperfusion and hemodynamic parameters, the kidney lost turgor and became mottled in appearance despite adequate hilar arterial and venous Doppler waveforms. Two aliquots of 40 μg (0.4 mL of a 100 μg/mL) nitroglycerin solution were injected directly into the renal artery 10 min apart. Nitroglycerin resulted in dramatic change in the consistency and appearance of the allograft. An improvement in renal blood flow was demonstrated by ultrasound after the second intra-arterial nitroglycerin injection with only a transient decrease in systemic arterial blood pressure. The child experienced normal allograft perfusion on serial postoperative ultrasounds, with a prompt decrease in serum creatinine and excellent diuresis. Intra-arterial nitroglycerin is a promising option for intra-operative arterial vasospasm during pediatric renal transplantation with objective improvement in blood flow and perfusion.
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Affiliation(s)
- Frank J Penna
- Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Elizabeth Harvey
- Division of Nephrology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Philip John
- Division of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Derek Armstrong
- Division of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Igor Luginbuehl
- Division of Anesthesia, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Rakan I Odeh
- Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Fahad Alyami
- Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
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Vascular fluorescence imaging control for complex renal artery aneurysm repair using laparoscopic nephrectomy and autotransplantation. Case Rep Transplant 2014; 2014:563408. [PMID: 25177511 PMCID: PMC4142551 DOI: 10.1155/2014/563408] [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: 06/25/2014] [Accepted: 07/24/2014] [Indexed: 11/26/2022] Open
Abstract
Intraoperative fluorescent imaging using indocyanine green enables vascular surgeons to confirm the location and states of the reconstructed vessels during surgery. Complex renal artery aneurysm repair involving second order branch vessels has been performed with different techniques. We present a case of ex vivo repair and autotransplantation combining the advantages of minimally invasive surgery and indocyanine green enhanced fluorescence imaging to facilitate vascular anatomy recognition and visualization of organ reperfusion.
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