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Li P, Yang X, Niu G, Yan Z, Zhang B, Yang M. Endovascular recanalization for pediatric hypertension secondary to total renal artery occlusion. J Vasc Interv Radiol 2024:S1051-0443(24)00232-X. [PMID: 38499268 DOI: 10.1016/j.jvir.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To assess the feasibility and efficacy of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH) secondary to total renal artery occlusion (RAO). METHODS From 2011 to 2021, 13 pediatric patients with RVH confirmed with 14 occluded renal artery lesions were reviewed. The mean age was11.2 years (range 4 to 16). Nine lesions involved main artery occlusion, while five lesions featured branch occlusion. Blood Pressure Ratio (BPR) was defined as the ratio of the actual BP value to the 95th percentile value adjusted for age, gender, and height. RESULTS PTRA was performed on nine patients (9/13, 69%). Technical success was achieved in five patients (5/9, 56%), with stent placement in two children (2/9, 22%). During the 12-month follow-up, restenosis was identified in two stent-receiving patients at the 12-month follow-up visit (2/9, 22%). Mean systolic BPR decreased from 1.20 ± 0.07 to 0.96 ± 0.06 (p = 0.003), mean diastolic BPR decreased from 1.19 ± 0.07 to 0.95±0.08 (p = 0.005) and the number of required medications decreased from 3.8 ± 0.8 to 2.4 ± 0.9 (p = 0.052) following PTRA. Subsequent to PTRA, the mean GFR of the occluded kidney improved from 19.5 ± 12.3 mL/ min to 36.3 ± 10.8 mL/ min (p = 0.007) and the mean longitudinal dimension of the affected kidneys significantly increased from 8.2 ± 1.5 cm to 9.2 ± 1.7 cm (p = 0.006). CONCLUSIONS Endovascular treatment is feasible for pediatric RAO, results in acceptable BP control and preserves renal function.
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Affiliation(s)
- Pengyu Li
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xinzhi Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Guochen Niu
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Ziguang Yan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Bihui Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Min Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
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Li HL, Chan YC, Guo Z, Zhou R, Cheng SW. Endovascular Thrombus Aspiration and Catheter-Directed Thrombolysis for Acute Thromboembolic Renal Artery Occlusion. Vasc Endovascular Surg 2022; 56:521-524. [PMID: 35392740 DOI: 10.1177/15385744221086136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We report a case of revascularization for an occluded renal artery using endovascular renal thrombus aspiration followed by catheter-directed thrombolysis. CASE REPORT A 56-year-old man presented with sudden onset severe left-sided abdominal and loin pain for 6 hours. Urgent computed tomography (CT) angiogram showed occlusion of left renal artery. Emergency selective left renal angiogram and thrombus aspiration using a 5-French Cobra catheter was performed. Catheter-directed thrombolysis with urokinase was initiated after aspiration thrombectomy. Angiogram 24 hours after thrombolysis showed the left renal artery and its segmental branches were successfully revascularized. Patient was put on anticoagulation after operation and his renal function recovered well. CONCLUSION Percutaneous aspiration thrombectomy with conventional catheters combined with intra-arterial local fibrinolysis could be used to salvage the renal function in case of complete renal artery thromboembolic occlusion.
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Affiliation(s)
- Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yiu Che Chan
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Division of Vascular & Endovascular Surgery, Department of Surgery, 71020University of Hong Kong Medical Centre, Hong Kong, China
| | - Zongjin Guo
- Department of Radiology, 444333The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ruming Zhou
- Department of Radiology, 444333The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Stephen W Cheng
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Division of Vascular & Endovascular Surgery, Department of Surgery, 71020University of Hong Kong Medical Centre, Hong Kong, China
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Wu LF, Shao L, Gao C, Wang X, Qi YH, Wang ZJ. [Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2022; 44:177-180. [PMID: 35300782 DOI: 10.3881/j.issn.1000-503x.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.
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Affiliation(s)
- Li-Fei Wu
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Lei Shao
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Chao Gao
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Xiang Wang
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Yu-Hang Qi
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Zi-Jun Wang
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
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Montanarella M, Harmon TS, Concepcion C, Pirris J, Matteo J. A Simple Target Will Save the Day and the Kidney: This Is How We Perform Our Endovascular Fenestrated Graft Procedure. Cureus 2021; 13:e14641. [PMID: 34046275 PMCID: PMC8141211 DOI: 10.7759/cureus.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With the advent of state-of-the-art imaging modalities, increasing population age, and advanced preventive medical treatments, medical device design attempts to keep up with procedural demand. An abdominal aortic aneurysm (AAA) is a recognized, potentially fatal disease process where strides have been made in screening, detection, and treatment since its discovery. With the introduction of percutaneous endograft procedures in 1991, open surgical treatment is nearly a lost art. Endovascular aortic repair is now the gold standard. However, short landing zone necks, hostile angulation, and markedly dilated seal zones present challenges for one size fits all endovascular aortic devices. Suprarenal and juxtarenal fenestrated aortic grafts are the most advanced individually customized grafts invented to date. Subsequently, proper placement of these complex devices still presents challenges. We present a method for preoperative renal stent placement for target purposes. This article includes a pictorial guide and describes the tips and pitfalls for easy proper AAA exclusion with a fenestrated aortic graft. We were successful in the deployment of the fenestrated graft device and the exclusion of an aortic aneurysm while preserving the patency of the renal arteries. The patient had no postoperative complications. During 18-month postoperative surveillance, imaging demonstrated proper graft positioning without evidence of an endoleak. In fenestrated endovascular aortic repair, preoperative renal stenting is paramount for targeting purposes. This allows for the precise and timely deployment of the renal limbs through the fenestrations while minimizing the risk of postoperative complications, including renal artery occlusion.
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Affiliation(s)
| | - Taylor S Harmon
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - John Pirris
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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Gong B, Ma M, Xie W, Yang X, Sun T. Retroperitoneal laparoscopic adrenalectomy with transient renal artery occlusion for large adrenal tumors (≥8 cm). J Surg Oncol 2018; 117:1066-1072. [PMID: 29448302 DOI: 10.1002/jso.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/10/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To analyze our experience in retroperitoneal laparoscopic adrenalectomy (RLA) with transient renal artery occlusion for large adrenal tumors (≥8 cm) and to explore the safety and feasibility of this surgical procedure. METHODS A retrospective cohort study was conducted with a surgical data review of 18 patients with large adrenal tumors who underwent RLA with transient renal artery occlusion in our hospital. RESULTS Eighteen patients were treated by RLA with transient occlusion of the renal artery, and none were converted to open adrenalectomy. The renal artery occlusion time, operative time, estimated blood loss, perirenal drainage time, postoperative hospital stay, and postoperative drainage were 7.6 ± 1.0 min, 176.3 ± 49.7 min, 247.2 ± 274.1 mL, 4.1 ± 1.02 days, 6.3 ± 1.4 days, and 73.6 ± 47.9 mL, respectively. No severe complications occurred, with the exception of hemodynamic instability in one patient with a pheochromocytoma and one transfusion during the operation. Only one case of adrenal crisis occurred postoperatively. Pathological examination revealed 9 cases of pheochromocytoma, 6 cases of adrenal myelolipoma, 1 case of adrenal ganglioneuroma, 1 case of hygromata, and 1 case of adrenal teratoma. No recurrence or evidence of metastasis was observed during the 7-to-30-month follow-up period. CONCLUSION RLA with transient renal artery occlusion is a feasible, effective, and safe treatment for large adrenal tumors (≥8 cm).
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Affiliation(s)
- Binbin Gong
- The Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ming Ma
- The Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Wenjie Xie
- The Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiaorong Yang
- The Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ting Sun
- The Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Visnagri A, Adil M, Kandhare AD, Bodhankar SL. Effect of naringin on hemodynamic changes and left ventricular function in renal artery occluded renovascular hypertension in rats. J Pharm Bioallied Sci 2015; 7:121-7. [PMID: 25883516 PMCID: PMC4399010 DOI: 10.4103/0975-7406.154437] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/27/2014] [Accepted: 09/02/2014] [Indexed: 12/01/2022] Open
Abstract
Background: Renal artery occlusion (RAO) induced hypertension is a major health problem associated with structural and functional variations of the renal and cardiac vasculature. Naringin a flavanone glycoside derived possesses metal-chelating, antioxidant and free radical scavenging properties. Objective: The objective of this study was to investigate the antihypertensive activity of naringin in RAO induced hypertension in rats. Material and Methods: Male Wistar rats (180-200 g) were divided into five groups Sham, RAO, naringin (20, 40 and 80 mg/kg). Animals were pretreated with naringin (20, 40 and 80 mg/kg p.o) for 4 weeks. On the last day of the experiment, left renal artery was occluded with renal bulldog clamp for 4 h. After assessment of hemodynamic and left ventricular function various biochemical (superoxide dismutase [SOD], glutathione [GSH] and malondialdehyde [MDA]) and histological parameters were determined in the kidney. Results: RAO group significantly (P < 0.001) increased hemodynamic parameters at 15, 30 and 45 min of clamp removal. Naringin (40 and 80 mg/kg) treated groups showed a significant decrease in hemodynamic parameters at 15 min. after clamp removal that remained sustained for 60 min. Naringin (40 and 80 mg/kg) treated groups showed significant improvement in left ventricular function at 15, 30 and 45 min after clamp removal. Alteration in level of SOD, GSH and MDA was significantly restored by naringin (40 and 80 mg/kg) treatment. It also reduced histological aberration induced in kidney by RAO. Conclusion: It is concluded that the antihypertensive activity of naringin may result through inhibition of oxidative stress.
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Affiliation(s)
- Asjad Visnagri
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India
| | - Mohammad Adil
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India
| | - Amit D Kandhare
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India
| | - Subhash L Bodhankar
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India
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Malagrino PA, Venturini G, Yogi PS, Dariolli R, Padilha K, Kiers B, Gois TC, da Motta-Leal-Filho JM, Takimura CK, Girardi ACC, Carnevale FC, Zeri ACM, Malheiros DMAC, Krieger JE, Pereira AC. Catheter-based induction of renal ischemia/reperfusion in swine: description of an experimental model. Physiol Rep 2014; 2:e12150. [PMID: 25263203 PMCID: PMC4270221 DOI: 10.14814/phy2.12150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 11/24/2022] Open
Abstract
Several techniques to induce renal ischemia have been proposed: clamp, PVA particles, and catheter-balloon. We report the development of a controlled, single-insult model of unilateral renal ischemia/reperfusion (I/R) without contralateral nephrectomy, using a suitable model, the pig. This is a balloon-catheter-based model using a percutaneous, interventional radiology procedure. One angioplasty balloon-catheter was placed into the right renal artery and inflated for 120 min and reperfusion over 24 h. Serial serums were sampled from the inferior vena cava and urine was directly sampled from the bladder throughout the experiment, and both kidneys were excised after 24 h of reperfusion. Analyses of renal structure and function were performed by hematoxylin-eosin/periodic Acid-Schiff, serum creatinine (SCr), blood urea nitrogen (BUN), fractional excretion of ions, and glucose, SDS-PAGE analysis of urinary proteins, and serum neutrophil gelatinase-associated lipocalin (NGAL). Total nitrated protein was quantified to characterize oxidative stress. Acute tubular necrosis (ATN) was identified in every animal, but only two animals showed levels of SCr above 150% of baseline values. As expected, I/R increased SCr and BUN. Fractional sodium, potassium, chloride, and bicarbonate excretion were modulated during ischemia. Serum-nitrated proteins and NGAL had two profiles: decreased with ischemia and increased after reperfusion. This decline was associated with increased protein excretion during ischemia and early reperfusion. Altogether, these data show that the renal I/R model can be performed by percutaneous approach in the swine model. This is a suitable translational model to study new early renal ischemic biomarkers and pathophysiological mechanisms in renal ischemia.
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Affiliation(s)
- Pamella A Malagrino
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Gabriela Venturini
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Patrícia S Yogi
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Rafael Dariolli
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Kallyandra Padilha
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Bianca Kiers
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Tamiris C Gois
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Joaquim M da Motta-Leal-Filho
- Interventional Radiology Unit, Department of Radiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Celso K Takimura
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Adriana C C Girardi
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Francisco C Carnevale
- Interventional Radiology Unit, Radiology Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ana C M Zeri
- Biosciences National Laboratory, LNBio, Campinas, SP, Brazil
| | | | - José E Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
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Ringe KI, Galanski M, Rosenthal H. Rescue from hemodialysis by late recanalization of renal artery occlusion. J Radiol Case Rep 2011; 5:19-23. [PMID: 22470792 DOI: 10.3941/jrcr.v5i5.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report on a patient with terminal renal insufficiency undergoing hemodialysis since four months. Imaging studies showed complete renal artery occlusion of a single kidney with collateral perfusion. Interventional recanalization of the renal artery was successful with a drop of serum creatinine from 1138 to 163 mol/l sparing the patient from further hemodialysis.
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Affiliation(s)
- Kristina Imeen Ringe
- Department of Radiology, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover, Germany.
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