A straight shot? The use of the right renal artery as inflow for hepatic arterial reconstruction.

Invited commentary

BackgroundMidaortic syndrome (MAS) is a rare vascular anomaly characterized by segmental narrowing of the distal descending thoracic or abdominal aorta. Renal or visceral arteries may also be affected to varying degrees. MAS is often associated with renovascular hypertension, and requires early intervention. When medical therapy and percutaneous interventions fail to control hypertension, surgical treatment is required. We report a case of MAS that failed to respond to bilateral renal artery stenting, but treated with aortic bypass and orthotopic right renal autotransplantation with good outcome.Case presentationA 31-year-old woman presented with headache and poorly controlled hypertension due to severe MAS. She had severe ostial stenoses of renal and visceral arteries. Her hypertension failed to respond to medical therapy (four drugs) and bilateral renal artery stenting. The implanted stent in the right renal artery rendered revascularization of the artery difficult. A one-stage revascularization was performed, which consisted of an aortoaortic bypass (between the suprarenal and infrarenal abdominal aorta) with a prosthetic graft, an orthotopic right renal autotransplantation and an aorto-left renal arterial bypass with autogenous saphenous vein grafts. Her recovery was uneventful. At 1-year follow-up, the patient remained well. Her hypertension improved. A postoperative computed tomography angiography showed that all the grafts were patent with no abnormalities at the anastomosis.ConclusionMultiple bypass surgery with reimplantation of autogenous vein graft onto the prosthetic graft is a feasible and effective procedure in renal artery revascularization for MAS. Orthotopic autotransplantation is the procedure of choice in complex renal artery reconstruction.

Coarctations of descending and abdominal aorta: Long-term results of surgical therapy

Guidelines for Noninvasive Vascular Laboratory Testing: A Report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology

OBJECTIVE.: Renal transplantation is generally accepted as one of the most effective treatment options for the end-stage renal disease. However, donor kidneys with multiple renal arteries represent a surgical challenge. For these cases, the surgical strategy is to directly anastomose multiple renal arteries to the internal iliac artery or the external iliac artery. However, this approach is complicated by the difficulty in performing the anastomoses, bleeding, stenosis, and a high incidence of false aneurysms. METHODS.: By applying the method of ex vivo reconstruction of the donor renal artery with the recipient internal iliac artery, we repaired five cases of donor kidneys with more than three renal arteries and excessively short renal arteries during transplantation and treated three cases of renal aneurysms with renal autotransplantation. RESULTS.: In all the cases, the surgery was without complications. At a minimum follow-up of 4 years, all patients showed normal renal function, and color Doppler ultrasonography indicated no thrombus or aneurysm formation or obstruction in the renal artery or its branches. CONCLUSIONS.: The ex vivo reconstruction of the donor renal artery with the recipient internal iliac artery is a feasible and effective surgical procedure for the transplantation of donor kidneys with multiple renal arteries and the autotransplantation of kidneys for the treatment of renal artery aneurysms.

Ex Vivo Repair and Renal Autotransplantation for Complex Renal Artery Aneurysms in a Solitary Kidney

A Novel Technique for Reconstruction of Multiple Renal Arteries in Live Donor Kidney Transplantation: A Case Report and Literature Review

Background: This was a prospective observational study to evaluate the incidence of Transplant Renal Artery Stenosis (TRAS) and Graft characteristics in Renal Transplant Recipients with Multiple Renal Arteries. Materials and Methods: In the present study 25 patients’ recipients of multiple renal artery graft kidney who underwent renal transplant after 30 the June 2016 till October 2017 with post-transplant serum creatinine ≤ 1.5mg/dL were included and evaluated for stenosis by CT Angiography done after period of 90 days. Results: In this study double renal artery was present in 96% patients and triple renal artery was present in 4% of patients. Only left laproscopic donor nephrectomy was done in all the cases. Arterial reconstruction was done by three techniques-double barreling done in 48% of cases, Y graft in 20% of cases and end to side anastomosis to main renal artery in 32% cases. Reconstructed renal artery was anastomosed to recipient external iliac artery by end to side anastomosis in 24% of patients and recipient internal iliac artery by end to end anastomosis in 76% of cases. Loupe was used during surgery in 28% of cases. Atheroma was present in 4% of donor vessels and 4% of recipient vessels. There was no technical difficulty in positioning of kidney in any of cases. There was incidence of delayed graft functioning in 8% of cases. There was no evidence of TRAS in any of cases on CT Angiography. There was no evidence of contrast induced nephropathy in this study group. Conclusion: In conclusion, there was no evidence of TRAS was found in any case. Hence no association could be established between occurrence of TRAS and various factors in patients with multiple renal artery live donor transplants with reconstruction.

Intraoperative duplex sonography during renal artery reconstruction

The role of arterial reconstruction in spontaneous renal artery dissection

Intraoperative assessment of renal and visceral artery reconstruction: The role of duplex scanning and spectral analysis

Absrract. A25-year-old male, with cutaneous neurofibromatosis, admitted with a history of intermittent headache, vomiting and hypertension for several years and attacks of palpitation and sweating for one year. Provocation tests with glucagon and histamine indicated a pheochromocytoma. Angiography of the renal artery revealed a pheochromocytoma in the left adrenal and a stenosis with an aneurysm of the right renal artery. Split renal function studies corresponded to a stenosis of the right renal artery. After removal of the tumour and vascular reconstruction of the right renal artery the patient was discharged in a normotensive state. Split renal function studies, sixteen months later, indicated a stenosis of the left renal artery which a renal angiography could not verify at least not in the main branches. As a result of the vascular reconstruction of the right renal artery, a remarkable increase in the size of the right kidney was noted roentgenologically. A possible explanation of the bewildering stenosis pattern in the split renal function studies postoperatively might be vascular changes in the intrarenal interlobar and/or arcuate arteries in the kidney, predominantly on the left side. The possibility of similar vascular changes in the small coronary vessels as an explanation of the ECG-changes appearing after the vascular reconstruction of the right renal artery stenosis is discussed. The combination between neurofibromatosis, renal artery stenosis and hypertension as well as neurofibromatosis, pheochromocytoma and hypertension have both been reported in the literature. Our case demonstrated hypertension, renal artery stenosis (and aneurysm), neurofibromatosis and pheochromocytoma, which seems to be a rare combination not previously described.

The OBJECTIVE was to evaluate the results of endovascular reconstruction in patients with dialysis-dependent ischemic kidney disease caused by bilateral renal artery disease. METHODS AND MATERIALS . From October 2017 to September 2024, in the Department of Vascular Surgery of the Pavlov First Saint Petersburg State Medical University, 174 patients (100 men and 74 women, mean age 65±7 years) underwent endovascular reconstruction of renal arteries, including 3 (2 %) patients with dialysis-dependent ischemic kidney disease. Preoperative examination of patients included an assessment of clinical manifestations, laboratory parameters (serum creatinine and urea levels, estimated glomerular filtration rate), ultrasound examination of the kidneys with an assessment of the thickness and condition of the parenchyma, parameters of extrarenal and intrarenal arterial blood flow (peak systolic blood flow velocity, resistivity indices), and performing catheter arteriography and/or CT angiography. In patients with dialysis-dependent ischemic kidney disease, indications for revascularisation were the hemodynamically significant damage to both renal arteries and signs of preserved renal parenchyma viability. In the immediate and late postoperative period, renal function was assessed based on clinical, laboratory, and instrumental data. RESULTS . Bilateral hemodynamically significant (stenosis > 50 % or occlusion) renal artery lesions were detected in 69 (40 %) patients. Clinical observations of 3 (2 %) patients are presented, in whom restoration of patency of one or both renal arteries through endovascular reconstruction allowed discontinuing haemodialysis. CONCLUSION . In the presented case series with occlusive-stenotic lesions of the renal arteries, 2 % of patients had a dialysis-dependent form of ischemic kidney disease. Timely endovascular reconstruction of the renal arteries in such patients can lead to regression of renal dysfunction and discontinuation of renal replacement therapy.

Long-segment thoracoabdominal aortic occlusions in childhood

Renal Artery Revascularization in Combination with Infrarenal Aortic Reconstruction