Acute Renal Artery Occlusion Research Articles

Treatment of Renal Artery Embolism

• Renal artery embolectomy was performed on four patients. There was no operative mortality. Four of the five affected kidneys were salvaged. The most common initial symptom was flank pain. The literature from 1970 to 1982 was reviewed to determine the current operative mortality (11%) and frequency of kidney salvage (67% to 90%) with surgery or anticoagulation. Newer treatment modalities, including intra-arterially injected low-dose streptokinase and percutaneous transluminal angioplasty, have also proved useful. The addition of these newer methods, combined with the fact that kidneys can frequently be salvaged after prolonged periods of acute renal artery occlusion, led to the development of a clinical algorithm for treatment. With this algorithm, surgical embolectomy was reserved for patients with total renal parenchymal compromise caused by emboli, whose conditions failed to respond to less invasive treatment modes. ( Arch Surg 1984;119:278-281)

Treatment of renal artery embolism.

Renal artery embolectomy was performed on four patients. There was no operative mortality. Four of the five affected kidneys were salvaged. The most common initial symptom was flank pain. The literature from 1970 to 1982 was reviewed to determine the current operative mortality (11%) and frequency of kidney salvage (67% to 90%) with surgery or anticoagulation. Newer treatment modalities, including intraarterially injected low-dose streptokinase and percutaneous transluminal angioplasty, have also proved useful. The addition of these newer methods, combined with the fact that kidneys can frequently be salvaged after prolonged periods of acute renal artery occlusion, led to the development of a clinical algorithm for treatment. With this algorithm, surgical embolectomy was reserved for patients with total renal parenchymal compromise caused by emboli, whose conditions failed to respond to less invasive treatment modes.

Sonographic evaluation of experimental acute renal arterial occlusion in dogs.

Eleven segmental and eight total renal artery occlusions were evaluated by sonography in transplanted kidneys of 19 adult mongrel dogs. The segmental occlusions were serially scanned daily or every other day for up to 35 days. The total occlusions were scanned daily for up to 10 days. Each occlusion was confirmed angiographically, and kidneys were examined pathologically. Acute segmental renal artery occlusion produces a sequence of sonographic changes, beginning with a focal hypoechoic mass at 24 hr, which stays unchanged for 5-7 days. At 7 days, internal echoes appear, and the infarct slowly consolidates to an echogenic, slightly depressed focus at 17 days. Total renal artery occlusion produced no appreciable change in cortical echogenicity and only slight increase in size. Acute segmental renal infarction can be detected early in its course and demonstrates a sequence of changes that may aid in dating the infarct. Total renal infarction may appear normal sonographically, and further studies are needed to confirm that diagnosis.

Acute Renal Artery Occlusion. The Role of Collateral Circulation

• It is not known if or when the probability of success is sufficient to warrant emergency revascularization of acute renal artery occlusion. This probability depends on the ability of collateral circulation to maintain viability. The role of collateral circulation in maintaining renal viability during six and 48 hours of renal artery occlusion has been studied in mongrel dogs. Collateral circulation is sufficient to maintain renal viability beyond the three hours of warm complete ischemia known to cause infarction. It is not sufficient to prevent progressive loss of renal function. Hypertension frequently results. Emergency revascularization of acute bilateral renal artery occlusion, therefore, is indicated. It is not indicated for unilateral occlusion with adequate contralateral function because of the high probability of resulting hypertension. (Arch Surg1982;117:801-804)

Collateral circulation after renal artery occlusion in the rat.

We used angiographic and microsphere methods to evaluate the anatomic and functional features of renal collateral circulation in the rat. By the microsphere method, renal parenchymal blood flow was less than 1% of control 1 hour after occlusion of the main renal artery; 2.8% of control 1-2 weeks after arterial occlusion; and 1% of control 4-9 weeks after occlusion. Radiographic observations during chronic occlusion revealed numerous collateral vessels to the kidney. These vessels readily filled with angiographic contrast medium but the intrarenal circulation did not visualize. We conclude that collateral circulation to renal parenchyma is negligible after acute or chronic occlusion of the main renal artery in the rat. The rich anatomic plexus of collateral vessels has no functional significance and is unable to preserve viability of the parenchyma.

Renal collateral blood supply after acute unilateral renal artery occlusion.

Preformed arterial collaterals are critical to renal parenchymal survival after acute total renal artery occlusion. This study was designed to delineate and quantify preformed collaterals and assess their response to vasodilators. A Swan-Ganz catheter induced a sudden, total occlusion of a renal artery sufficient to reduce distal arterial pressure to near zero and prevent perfusion through the renal artery. Arteriography assessed the effectiveness of the occlusion and delineated the collateral arterial pathways. Strontium, cerium-, and chromium-labeled microspheres measured renal blood flow and cardiac output 1, 60, and 120 minutes after occlusion. In two additional series of experiments either contralateral nephrectomy was performed 5 to 8 days before the study, or dibenzylene, dopamine, or glucagon were administered in an attempt to increase blood flow through the collaterals. Collateral renal blood flow was demonstrated in all dogs. Mean blood flow to the occluded kidneys ranged from 0.13 +/- 0.05 cm3/minute/g to 0.22 +/- 0.08 cm3/minute/g, about 5% of control values. Neither prior contralateral nephrectomy nor vasodilator agents increased the flow to the obstructed kidneys. In the dogs with intact contralateral kidneys, however, there was a progressive decrease in cardiac output during the experiment, which was not found in uninephrectomized animals. We concluded that preformed arterial channels are available to maintain a small, but probably critical level of perfusion following sudden total occlusion of the renal artery. Neither hypertrophy due to prior contralateral nephrectomy nor active vasodilators modify flow through the preformed channels. It is likely that total renal ischemia provides a maximal stimulus for vasodilatation. The pattern of hind limb collaterals differed strikingly from those of the kidney, with maintenance of a greater portion of a normal flow and rapid increase in flow within 1 hour after femoral artery occlusion. Thus, data concerning collateral circulation cannot be generalized from one vascular bed to another even in the same species.

Removal of iatrogenic clot by transcatheter embolectomy.

HomeRadiologyVol. 111, No. 1 PreviousNext ArticlesRemoval of Iatrogenic Clot by Transcatheter EmbolectomyDonald R. Buxton, Jr., Charles F. MuellerDonald R. Buxton, Jr., Charles F. MuellerAuthor Affiliations Department of Radiology University of New Mexico School of Medicine Albuquerque, N.M. 87106Donald R. Buxton, Jr.Charles F. MuellerPublished Online:Apr 1 1974https://doi.org/10.1148/111.1.39MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractTranscatheter embolectomy offers an immediate alternative to surgical or medical management of iatrogenic clot formation during arteriography. With this technique, the angiographer may remove the major arterial embolus and confirm patency of the vessel within minutes.Article HistoryAccepted: Sept 1973Published in print: Apr 1974 FiguresReferencesRelatedDetailsCited ByAdjunctive techniques in percutaneous mechanical thrombectomyMarcKalinowski, Hans-JoachimWagner2003 | Techniques in Vascular and Interventional Radiology, Vol. 6, No. 1Current Status of Percutaneous Mechanical Thrombectomy. Part III. Present and Future ApplicationsMelhem J.A.Sharafuddin, Marshall E.Hicks1998 | Journal of Vascular and Interventional Radiology, Vol. 9, No. 2Forschung mit RöntgenstrahlenRolf W.Günther, DierkVorwerk, ClausPfannenstiel1995Aspiration Thromboembolectomy of an Acute Renal Artery Occlusion with the Hieshima Coaxial CatheterRichard R.Saxon, Jeanne M.LaBerge, Ernest J.Ring1991 | Journal of Vascular and Interventional Radiology, Vol. 2, No. 3Renal Artery Emboli: The Role of Surgical TreatmentSamuelBouttier, Jean-PierreValverde, MichelLacombe, OscarNussaume, BernardAndreassian1988 | Annals of Vascular Surgery, Vol. 2, No. 2Bilateral renal artery embolism: A diagnostic and therapeutic problemRobert E.Jones, Curtis G.Tribble, Charles J.Tegtmeyer, George B.Craddock, Robert M.Mentzer1987 | Journal of Vascular Surgery, Vol. 5, No. 3Interventional Angiography of the Renal FossaMarlene R.Eckstein, Arthur C.Wattman, Christos A.Athanasoulis1984 | Radiologic Clinics of North America, Vol. 22, No. 2Low dose streptokinase in the treatment of arterial occlusionsBTKatzen, Avan Breda1981 | American Journal of Roentgenology, Vol. 136, No. 6Therapeutic Applications of AngiographyChristos A.Athanasoulis1980 | New England Journal of Medicine, Vol. 302, No. 21Therapeutic applications of angiography: State of the artGerald D.Pond, Theron W.Ovitt1979 | Current Problems in Diagnostic Radiology, Vol. 8, No. 3Lysis of Thrombus in Internal Carotid Artery in the NeckCharles E.Seibert, Wendel B.Swanson1975 | Acta Radiologica. Diagnosis, Vol. 16, No. 347_supplRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 111, No. 1 Metrics Altmetric Score PDF download

Acute Renal Artery Occlusion: Etiology, Diagnosis and Treatment. Report of a Case with Subsequent Revascularization

Acute Renal Artery Occlusion: Etiology, Diagnosis and Treatment. Report of a Case with Subsequent Revascularization

Management of acute and subacute renal artery occlusion

Management of acute and subacute renal artery occlusion

Acute occlusion of renal artery demonstrated by angiography : S. H. Cornell, and D. A. Culp. J. Urol. 100:2–5 (July) 1968

Acute occlusion of renal artery demonstrated by angiography : S. H. Cornell, and D. A. Culp. J. Urol. 100:2–5 (July) 1968

Acute Bilateral Renal Artery Occlusion in Man

Introduction EXTENSIVE SURGICAL procedures on the abdominal aorta are now common. Renal complications following such surgery occasionally occur. Many cases of oliguria result from either periods of surgical shock associated with the operative procedure or from poorly understood reactions in the kidneys to the cross clamping of the aorta below the renal arteries. Considerable attention has been given to these problems of acute tubular damage with associated oliguria or anuria during the last few years and progress has been made in supporting these patients during the phase of renal impairment with rigid medical management and often dialysis. Most cases of anuria occurring immediately after surgery can be related to hypotension or surgical shock. Others previously thought to be due to the altered physiology involved in cross clamping the infrarenal aorta may actually be due to bilateral renal artery occlusions or of most of the major branches. An accurate and immediate