Renal Angiography Research Articles

Role Of Renal Artery Embolization In Treatment Of Iatrogenic Renal Bleeding.

To review institutional experience about the effectiveness and safety of percutaneous trans-arterial renal artery embolization in the treatment of iatrogenic renal bleeding. The prospective study was conducted from December 2019 to December 2021 at Ain Shams University Hospital and Kafrelsheikh University Hospital, Egypt, and comprised patients of either gender who underwent renal artery embolization for iatrogenic arterial renal bleeding caused by percutaneous nephrolithotomy, renal biopsy and percutaneous nephrostomy. Diagnostic renal angiography was done to detect pseudoaneurysm and arteriovenous fistula. Embolization was done with either micro-coils or glue. Success of the procedure was defined astotal occlusion of the bleeding artery proved by post-embolization angiogram. Of the 15 patients, 9(60%) were males and 6(40%) were females. The overall mean age was 35+/-14 years. Percutaneous nephrolithotomy was the main cause 8(53.3%), followed by renal biopsy 5(33.3%) and percutaneous nephrostomy 2(13.2%). There were 9(50%) cases of pseudoaneurysm and 6(40%) of arteriovenousfistula. Embolization was done with micro-coils in 5(33.3%) cases and with glue in 10(66.6%). The technical success rate was 15(100%). No major complicationsrequiring intensive care orsurgical intervention were encountered, and there was no significant differences in estimated glomerular infiltration rate or renal function after renal artery embolization (p>0.05). Percutaneous endovascular renal artery embolization was found to be a safe and effective technique in the management of iatrogenic renal arterial injury.

IMAGING EVALUATION OF IATROGENIC RENAL VASCULAR INJURIES AND THEIR ENDOVASCULAR MANAGEMENT

Objective: To study the role of USG Doppler, CT renal angiography in evaluation of iatrogenic renal vascular injuries and to assess the effectiveness & safety of endovascular intervention of Iatrogenic Renal Vascular Injuries (IRVIs). Materials and methods: A total of 23 patients with IRVIs were initially evaluated with USG Doppler followed by CT angiography and DSA was performed in 20 patients. Four out of 23 patients showed spontaneous resolution as confirmed by preprocedural USG Doppler. Endovascular embolization of IRVIs was performed using micro coils in 19 patients. Technical success was confirmed at the end of the procedure by a renal angiogram. The patients were followed up for a period of 6 months to assess the clinical success. Results: The most common cause of IRVI in our study was PCNL seen in 16(70%) patients followed by Partial Nephrectomy and PCN. All patients presented to us within 10-14 days of the etiological event with hematuria flank pain or drop in hematocrit. USG was able to detect IRVIs in the form of RAPs in 17(74%) and perirenal/intrarenal hematoma in 2(7%) cases. CT angiography was able to detect IRVIs in all the patients, however, additional aneurysms in two patients were not detected which were later seen on DSA renal angiography. Embolization was performed for 21 aneurysms in 19 patients using micro coils and showed 100 % technical and clinical success. Conclusion: USG Doppler and CT angiography play a very important role in diagnosis of iatrogenic renal vascular injuries. Endovascular embolization is an effective and safe method for management of injuries.

Renal infarction caused by fibromuscular dysplasia

Introduction: Fibromuscular dysplasia (FMD) is an atherosclerotic/non-inflammatory disease, usually involving the renal and internal carotid arteries. Renal infarction is a rare condition that can present with flank pain and can be caused by FMD. Case Report: A 49-year-old female patient was admitted to the emergency department with complaints of flank pain, fever, nausea, vomiting, and chills. Her blood pressure was normal. Abdominal examination showed right costovertebral tenderness. Laboratory assessment showed hematuria, leukocytosis, increased C-reactive protein (CRP), and increased lactate dehydrogenase (LDH). Nephrolithiasis was strongly considered a cause of pain because of the nature of the pain and the presence of hematuria. The urinary system ultrasound was normal. On the computed tomography (CT), in contrastenhanced sections, an infarct area was detected in the lower pole of the right kidney. In renal angiography, severe focal stenosis was seen in the polar renal artery, and angioplasty was made. Conclusion: Renal infarction can be caused by FMD and may be misdiagnosed as renal colic.

Renal pseudoaneurysm after holmium laser lithotripsy with flexible ureteroscopy: an unusual case report and literature review

Pseudoaneurysms of the renal arteries are caused by focal rupture or perforation of the arterial wall, resulting in local bleeding. Such pseudoaneurysms can be observed in conditions such as nodular polyarteritis, penetrating or closed renal injury, and medically induced injuries (such as renal puncture biopsy, percutaneous nephrostomy, or partial nephrectomy). Flexible ureteroscopy (FURS) is performed entirely through the urethra to prevent potentially severe kidney damage. Because of this, almost no renal parenchymal hemorrhage occurs after FURS laser lithotripsy. Only four cases had been documented in the literature as of December 2022. In this report, we describe a 53-year-old man with a history of recurrent kidney stones who underwent FURS laser lithotripsy for bilateral kidney stones. The procedure was smoothly performed, and no active bleeding occurred. However, the patient developed recurrent macroscopic hematuria after discharge from the hospital, and renal angiography revealed a pseudoaneurysm in the distal right kidney. The pseudoaneurysm was treated with selective arterial embolization. Serious complications of FURS surgery are rare, particularly the formation of pseudoaneurysms. We report the present case to bring this potential complication to the attention of urologists.

Characteristics and predictors of low-grade renal artery stenosis in female patients with CKD

ABSTRACT Aim Renal artery stenosis (RAS) is an important cause of chronic kidney disease (CKD). The main purpose of this study was to explore the clinical characteristics and predictors of low-grade RAS in female patients with CKD. Methods One hundred and five female CKD patients from Huadong Hospital affiliated with Fudan University who underwent 3 T non-contrast renal artery magnetic resonance angiography (MRA) were analyzed. Basic statistics methods were used in the study, such as independent-sample t test,non-parametric test, binary logistic regression analysis and ROC analysis. Results In this cross-sectional study, there were 50 patients with RAS and 55 without RAS (47.6% versus 52.4%). Binary logistic regression analysis demonstrated that low-level ALB and lymphocyte count, high-level SP, BUN and NLR were independent risk factors for low-grade RAS in female patients with CKD. ROC analysis indicated that eGFR, FeNa and UBCR, ALB, lymphocyte count and NLR had the best predictive value for low-grade RAS, especially eGFR with a sensitivity of 65.50% and specificity of 72.00% and FeNa with a sensitivity of 71.10% and specificity of 72.20% and BUCR with a sensitivity of 71.10% and specificity of 68.10%. Conclusion In female patients with CKD, FeNa, eGFR, ALB, UBCR, lymphocyte count and NLR may be good predictors of low-grade RAS, especially eGFR, FeNa and BUCR.

ANALYSIS OF POST PROCESSING TECHNIQUE CT RENAL ANGIOGRAPHY FOR IDENTIFICATION OF VARIATIONS OF RENAL ARTERIES IN KIDNEY DONOR PREPARATION: LITERATURE REVIEW

Visualization of renal artery variations is a prerequisite for kidney donors. Polar variations and number of renal arteries were identified using several prost processing techniques Renal CT Angiography. Objective : To identify variations in the number and polarity of the renal arteries using MPR, MIP, CPR and 3D VR based on a literature review. Analysis with a literature review approach was carried out using secondary data sources from 2012-2022 scientific publication journal articles by comparing the number and polarity of the renal arteries from the MPR, MIP, CPR and 3D VR post-processing techniques on CT renal angiography. MIP and 3D VR are the optimal combination of post-processing techniques for identification of the number and polarity of the renal arteries. The combination of MIP and 3D VR post processing techniques is the optimal post processing technique in depicting the number and polar variations of the renal arteries

Prevalence and clinical characteristics of renovascular hypertension associated with fibromuscular dysplasia in China.

The aim of this study was to investigate the clinical characteristics of renal artery fibromuscular dysplasia (FMD) in patients in China and identify the cure rate of hypertension after angioplasty. Consecutive hypertensive patients with renal artery stenosis caused by FMD who underwent catheter-based angiography, and were followed at two Chinese referral centres, were retrospectively analysed. All patients underwent a detailed investigation, including demographic characteristics, clinical characteristics, biochemical sampling, Doppler ultrasonography of carotid arteries, magnetic resonance angiography (MRA) of the intracranial artery, and CTA or MRA of the abdominal artery and catheter-based renal angiography. Patients were routinely followed up at 1 month, 6 months and every year after the procedure. Among 245 study participants, with a mean diagnosed age of 26.9 ± 9.9 years, 137 (55.9%) were women, and 38 (15.5%) were children. All patients were diagnosed with hypertension at a mean age of 23.4 ± 8.4 years. There were 73.5% focal and 15.2% multivessel cases. Aneurysms, arterial dissections and total occlusions were found in 21.6, 4.1 and 12.2% of patients, respectively. Patients with multifocal FMD were older (26.0 vs. 23.7 years, P = 0.021) and more often female (70.8 vs. 50.6%, P = 0.004). Among children with renal FMD, 55.2% were men, and 86.8% were focal. After a median follow-up of 7.0 years, multifocal FMD had a higher cure rate of hypertension than focal FMD after revascularization (71.7 vs. 55.8%, P = 0.032). In a cohort of mostly young Chinese patients, the prevalence of hypertension associated with renal FMD is similar in both sexes. Focal FMDs were more frequent than the multifocal ones and, after angioplasty, were associated with a worse blood pressure outcome.

The Utility of Unenhanced Renal Artery Magnetic Resonance Angiography Using Inhance Sequence in Depiction of Renal Vasculature and Related Abnormalities in Patients with Suspected Renovascular Hypertension

The Utility of Unenhanced Renal Artery Magnetic Resonance Angiography Using Inhance Sequence in Depiction of Renal Vasculature and Related Abnormalities in Patients with Suspected Renovascular Hypertension

Recellularization of Acellular Xeno Kidney Scaffold: An In Vivo Method to Generate Bioartificial Kidney.

A significant hurdle for kidney tissue engineering is reproducing the complex three-dimensional structure of the kidney. In our study, a stepwise approach of generating a reproducible Xeno kidney scaffold from a goat kidney is described, which can be implanted and recellularized by host cells. We have proposed a combination of sodium dodecyl sulfate and Triton-X-100-based protocol to generate a reproducible Xeno kidney scaffold, which was then analyzed by histology, DNA quantification, SEM, and renal angiography. Further, a small portion from the cortico-medullar region of the acellular scaffold was implanted in the rat's kidney subcapsular pocket for a period of 1 month, to check the recruitment of host cells into the scaffold. Post implantation, the extracellular matrix of the scaffold was well preserved and it did not induce any damage or inflammation in the native kidney. Implantation of the Xeno scaffold resulted in apparent early vascularization which helped in the recruitment of the host cells, which was characterized by histology, immunohistochemistry, and scanning electron microscopy. Implanted Xeno scaffold showed AQP-1, Nephrin, α-SMA, and VEGF expression in proximal tubules and renal glomerulus. Importantly, Ki-67 and WTAP-expressing cells were also observed near proximal tubules suggesting a high level of proliferation in the scaffold. Thus, showing the potential of Xeno kidney development that can be recellularized by the host cell to engineer into a functional kidney.

PS-BPR02-9: RECURRENCE OF RENAL ARTERY STENOSIS BY PONATINIB, A MULTI-TARGETED TYROSINE-KINASE INHIBITOR

Introduction: Cardiovascular disease and drug induced hypertension have been reported with tyrosine-kinase inhibitor including ponatinib treatment in chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). We report bilateral renal artery stenosis (RAS) in a patient who had received ponatinib for relapsing Ph+ALL after 2nd allogeneic stem cell transplantation. Case: A patient was a 40-year-old woman with no history of cardiovascular disease and hypertension. She developed myocardial damage that appeared to be ponatinib -induced, and catheterization of the heart revealed multiple coronary artery lesions and started optical medical therapy. 16 months after ponatinib treatment, she was referred to the nephrology department for evaluation of hypertension and increase in serum creatinine from 1.47 to 2.02 mg/dL. Renal ultrasonography and MRI revealed significant stenosis of the right renal artery, and angiography and stenting were performed. 5 months after the stent treatment, progression of renal dysfunction due to exacerbated RAS was observed. Intravascular ultrasonography revealed diffuse intimal thickening occurred in-stent restenosis, and balloon dilation was performed. She required balloon dilatation a total of three times even after the discontinuation of ponatinib treatment. The patient was thought to have systemic vascular endothelial damage caused by ponatinib. Discussion: It should be considered when hypertension and renal dysfunction occurs after ponatinib use

PS-C27-4: CONTROLLED RESISTANT HYPERTENSION FOLLOWING A SUCCESSFUL RENAL ARTERY STENTING: A RARE CASE REPORT IN A DEVELOPING COUNTRY

Introduction: Renal artery stenosis is among the etiologies of secondary hypertension in which the diagnosis and therapy are difficult. We report a case of a patient suffered from uncontrollable hypertension with frequent episode of malignant hypertension, treated with renal artery stenting. Case Description: A 36-year-old female visited cardiovascular policlinic on a routine control for her hypertension. Having diagnosed with hypertension for two years, he had several episodes of malignant hypertension. At the beginning of her treatment, she was prescribed an angiotensin-converting-enzyme inhibitor yet her pressure was not only uncontrolled but also worsen. By the visit, she was medicated using two alpha-2-adrenergic agonists, a loop diuretic, a beta-blocker, a calcium-channel blocker, an angiotensin-receptor blocker, and an aldosterone-receptor antagonist without any satisfactory outcome on her blood pressure status. She had a blood pressure of 196/130 mmHg with tachycardia of 112 times/minute. We found cardiomegaly on physical examination which proven by chest x-ray. Echocardiography indicated hypertensive heart disease. Screening for secondary hypertension, including laboratory tests (complete blood count, potassium, sodium, creatinine, fasting glucose, fasting lipid profile, urinalysis, thyroid stimulating hormone, 24H urinary free cortisol) suggested normal results. Renal ultrasound and doppler were also conducted and showed a suspicion of right renal artery stenosis. Therefore, angiography of the renal artery was conducted for diagnostic and therapy when indicated. The angiography suggested a normal left renal artery while the right artery had a 95% stenosis on the proximal part. An intravascular ultrasound-guided percutaneous transluminal angioplasty on her right renal artery was conducted and two vascular stents were implanted. The patient showed a remarkable development following her decreasing blood pressure on follow-up. After 1 week, her blood pressure is now controllable on a single antihypertensive and antiplatelet therapy. Conclusion: The diagnosis and management of a patient with resistant hypertension might be challenging, particularly in the setting of a developing country. Renal artery angiography, among other examination, might be crucial in the diagnosis sequence, yet was not always readily available. We present a case in which diagnosis of renal artery stenosis was made followed by a definite treatment resulting in a remarkable hypertension control. An identifiable etiology is the key to a proper and the best treatment option for the patient.

Remember Diabetes Mellitus When Assessing Renal Blood Flow in Hypertensive Patients: A Renal Frame Count Study.

Diabetes mellitus (DM) progresses with dynamic changes in renal blood flow and glomerular filtration. Renal frame count (RFC) is a cineangiographical parameter that is capable of presenting microvascular and macrovascular changes in the renal blood flow. We aimed to show the changes, which may be caused by DM in the perfusion, by using RFC. Totally 110 hypertensive subjects consisting of 55 DM patients and 55 non-DM patients as a control group who underwent renal angiography were retrospectively enrolled in the study. The RFC values of all subjects were calculated and compared to each other. There were no significant differences between the two groups in terms of basal demographic characteristics and antihypertensive medications. The RFC value measured from the left renal artery was significantly lower in the DM group compared to the control group. (11.33±2.55, 13.49±3.24, respectively; p<0.001). The RFC value measured the right renal artery was detected to be significantly lower in the DM group than the control group (11.07±2.43, 13.33±3.07, respectively; p<0.001). The mean RFC value was also significantly lower in the DM group compared to the control group (11.20±2.18, 13.41±2.84, respectively;p<0.001). In the multivariable linear regression analysis conducted to determine the variables which may affect mean RFC, it was determined that only the HbA1C level had a relation with the mean RFC value. To the best of our knowledge, this is the first study to show the influence of DM on RFC. RFC seems to decrease in DM subjects.

Combined method of renal denervation in an animal model

Background: Currently, intra-arterial radiofrequency renal denervation is an only interventional treatment for resistant hypertension. However, available data are controversial since this method does not provide the long-term hypotensive effect.Objective: To compare the safety and efficacy of laparoscopic mechanical renal denervation and laparoscopic combined renal denervation using a radiofrequency clamp.Methods: Thirty sheep weighing 93.00 ± 3.72 kg were divided into two groups for mechanical laparoscopic renal denervation (group I, n = 15) and combined laparoscopic renal denervation with a radiofrequency clamp (group II, n = 15). The observation period lasted for six months. We assessed the following parameters: blood pressure (BP) in response to high-frequency electric stimulation from the lumen of the vessel, creatinine and uric acid levels, iatrogenic damage to the renal arteries based on angiography findings, and destruction of nerve fibers based on histological findings.Results: All the animals survived throughout the observation period. Creatinine and uric acid levels were within the normal ranges. Renal angiography did not reveal any iatrogenic stenosis. After six months, we found some BP response (elevated systolic BP ∆66.73 ± 6.63 mm Hg [p &lt; 0.001], elevated diastolic BP ∆47.27 ± 5.98 mm Hg [p &lt; 0.001]) to high-frequency electric stimulation in group I and no hypertensive response in group II. After six months, the animals were withdrawn for further histological assessment. Histology revealed complete destruction of the nerve fiber (demyelination) in group II and vacuolized swollen nerve fibers without any signs of demyelination in group I.Conclusion: Laparoscopic combined renal denervation is a safe and efficacious method with a stable hypotensive effect after six months in an animal model as compared to laparoscopic mechanical renal denervation. Received 30 March 2022. Revised 5 December 2022. Accepted 9 December 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: D.I. Bashta, L.I. Vilenskiy, A.B. RomanovData collection and analysis: D.I. Bashta, Yu.S. Krivosheev, A.A. SimonyanStatistical analysis: D.I. Bashta, Yu.S. KrivosheevDrafting the article: D.I. Bashta, Yu.S. Krivosheev Critical revision of the article: L.I. Vilenskiy, Yu.S. Krivosheev, A.B. Romanov Final approval of the version to be published: D.I. Bashta, L.I. Vilenskiy, Yu.S. Krivosheev, A.A. Simonyan, A.B. Romanov

Use of surgical augmented intelligence maps can reduce radiation and improve safety in the endovascular treatment of complex aortic aneurysms

ObjectiveThe introduction of endovascular procedures has revolutionized the management of complex aortic aneurysms. Although repair has traditionally required longer operative times and increased radiation exposure compared with simple endovascular aneurysm repair, the recent introduction of three-dimensional technology has become an invaluable operative adjunct. Surgical augmented intelligence (AI) is a rapidly evolving tool initiated at our institution in June 2019. In our study, we sought to determine whether this technology improved patient and operator safety. MethodsA retrospective review of patients who had undergone endovascular repair of complex aortic aneurysms (pararenal, juxtarenal, or thoracoabdominal), type B dissection, or infrarenal (endoleak, coil placement, or renal angiography with or without intervention) at a tertiary care center from August 2015 to November 2021 was performed. Patients were stratified according to the findings from intelligent maps, which are patient-specific AI tools used in the operating room in conjunction with real-time fluoroscopic images. The primary outcomes included operative time, radiation exposure, fluoroscopy time, and contrast use. The secondary outcomes included 30-day postoperative complications and long-term follow-up. Linear regression models were used to evaluate the association between AI use and the main outcomes. ResultsDuring the 6-year period, 116 patients were included in the present study, with no significant differences in the baseline characteristics. Of the 116 patients, 76 (65.5%) had undergone procedures using AI and 40 (34.5%) had undergone procedures without AI software. The intraoperative outcomes revealed a significant decrease in radiation exposure (AI group, 1955 mGy; vs non-AI group, 3755 mGy; P = .004), a significant decrease in the fluoroscopy time (AI group, 55.6 minutes; vs non-AI group, 86.9 minutes; P = .007), a decrease in the operative time (AI group, 255 minutes; vs non-AI group, 284 minutes; P = .294), and a significant decrease in contrast use (AI group, 123 mL; vs non-AI group, 199 mL; P < .0001). No differences were found in the 30-day and long-term outcomes. ConclusionsThe results from the present study have demonstrated that the use of AI technology combined with intraoperative imaging can significantly facilitate complex endovascular aneurysm repair by decreasing the operative time, radiation exposure, fluoroscopy time, and contrast use. Overall, evolving technology such as AI has improved radiation safety for both the patient and the entire operating room team.

Incidence of renal artery stenosis and its hemodynamic significance in patients subjected to angiography for suspected coronary artery disease

Background: Renal artery stenosis (RAS) may occur alone (isolated anatomical RAS) or in combination with hypertension (renovascular or essential hypertension), renal insufficiency (ischemic nephropathy), or both. Renal artery stenting can be performed safely with nearly uniform technical success without exposing them to significant incremental risk. Aims and Objectives: The objectives of the study are as follows: (A) To study the incidence of RAS in suspected coronary artery disease patients. (B) To study the hemodynamic significance of RAS in patients diagnosed having RAS. (C) Should patients undergoing coronary angiography be subjected to routine renal angiography during the procedure? Materials and Methods: We prospectively did renal angiography of consecutive 100 patients, who underwent coronary angiography for their suspected coronary artery disease. Data regarding risk factors were recorded for every patient. Results: Out of 12 patients with RAS, 10 had significant stenosis (&gt;50%) out of which seven patients showed hemodynamically significant RAS on captopril renogram. These were the patients having stenosis of 70% or more on renal angiography. Three patients having RAS 50–70% on renal angiography were not having hemodynamically significant lesion on captopril renograms. Conclusion: Renal angiography should be performed in patients undergoing coronary angiography. Femoral artery should be the preferred access site for coronary angiography to approach renal arteries. The patients with RAS should undergo captopril renography to evaluate the hemodynamic significance of the stenosis.

Comparison of Turbo Flash and dual-energy modes of third-generation dual-source CT in pre-transplant renal angiography: a prospective observational study

BackgroundThe purpose of this study was to compare the Image Quality, Contrast Medium Volume, and Radiation dose in renal angiography performed using Turbo Flash mode and dual-energy (DE) mode in the third-generation dual-source dual-energy CT.This prospective observational study was performed on renal donors who underwent CTA imaging as a pre-transplant workup. The study population was divided into two groups. Group A underwent DECT renal angiography. Group B underwent Turbo Flash Mode CT renal angiography. For group A, a contrast volume of 1 ml/kg and for group B at 0.5 ml/kg was administered. Image Quality was evaluated objectively by calculating CNR and SNR and subjectively by a 5-point scale. Radiation Dose analysis was done by noting CTDIvol and DLP on the scanner system and calculating effective radiation dose (ED).ResultsThe subjective image quality scores for the Turbo Flash group were comparable with the DE group in qualitative image analysis. Additionally, in the Turbo Flash group, there was a reduction in contrast media and effective radiation dose by 47.5% and 32.7%, respectively. Nevertheless, mean attenuation of the abdominal arteries, CNR, SNR, and Noise (S.D) showed statistical significance between the two groups (p value < 0.01).ConclusionsTo our knowledge, no previous study compared Turboflash mode with DE protocol in CT renal angiography in a donor group of patients. Turbo Flash CT is an excellent modality that is faster and has an added advantage of decreased radiation dose and contrast media volume reduction, which can be recommended for screening of voluntary kidney donors but needs further clinical studies, validation, and standardization with tailored protocols.

Endovascular Management of Iatrogenic Renal Vascular Injuries: Case Series and Systematic Review.

To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients. Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020. 18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine (p = 0.51), urea (p = 0.37), hemoglobin (p = 0.26) and hematocrit (p = 0.24) after embolization. EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients.

Renal arterial embolization: Indications, angiographic findings, and outcomes in a series of 170 patients.

The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization (RAE) compelled us to report our overall experience on a series of patients. A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019. History, physical examination, and laboratory data were reviewed for all patients. Abdominal ultrasound was the initial imaging study, and all patients underwent subsequent computed tomography or magnetic resonance imaging. The outcome of RAE was determined based on radiographic and clinical findings. Data from 202 patients were analyzed, with a mean age of 45 ± 15 years, and 71.3% of patients were male. Iatrogenic injury was the most common indication for RAE (54%), followed by renal tumors, trauma, and spontaneous, in 27.7%, 10.4%, and 8.4% of patients, respectively. Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding (40.6%), whereas no lesions were identified on angiography in 32 patients (15.8%), after which RAE was subsequently aborted. Renal arterial embolization was successful in 158 of 170 patients (92.9%) after 1 or more trials (maximum of 4). Microcoil alone or with other embolic materials was the most commonly used material for embolization (85%). Iatrogenic injury was the most common indication for RAE. Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography; however, angiography showed a negative result in 16% of patients, even those with symptoms. When lesions are present on angiography, the overall success of repeated trials of RAE reached 92.9%.

Renal pelvis mucosal artery hemorrhage after percutaneous nephrolithotomy: a rare case report and literature review

BackgroundFollowing a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients with postoperative bleeding can be treated conservatively, causing the perirenal hematoma to resolve spontaneously. The major causes of severe postoperative bleeding are pseudoaneurysms, arteriovenous fistula, and segmental arterial injury. Typically, the first choice of treatment to manage severe bleeding complications is selective angioembolization (SAE) because of the very high success rate associated with this procedure.Case presentationThis clinical case involves a 56-year-old man who underwent dual-channel PCNL treatment after diagnosing a left kidney staghorn stone and urinary tract infection. The operation was successful, with no apparent signs of bleeding. Tests revealed continued decreasing hemoglobin levels following the procedure. After the conservative treatment failed, renal angiography was performed immediately, indicating renal pelvis mucosal artery hemorrhage. In the three hours post-surgery, the SAE still failed to prevent bleeding. Further discussions led to formulating a new surgical plan using a nephroscope to enter the initial channel where hemostasis began. The hemostasis origin was found precisely in the mucosal artery next to the channel during the operation and was successfully controlled.ConclusionsThis case reveals there is poor communication and inadequate discussions about the potential failures of an SAE procedure. Swift clinical decision-making is imperative when dealing with high-level renal trauma to prevent delays in surgery that can threaten the safety of patients.

Presentation, treatment, and outcome of renovascular hypertension below 2 years of age

Renovascular hypertension in most cases requires endovascular treatment and/or surgery. This is technically much more difficult in small children and there is very limited published knowledge in this age group. We here present treatment and outcome of young children with renovascular hypertension at our institution. Children below 2 years of age, with renovascular hypertension between January 1998 and March 2020 were retrospectively reviewed. Demographics and treatment modalities were noted. Primary outcome was blood pressure within a week after the procedures and at last available visit. Sixty-six angiographies were performed in 34 patients. Median age at time of first angiography was 1.03 (interquartile range (IQR) 0.4–1.4) years and systolic blood pressure at presentation 130 (IQR 130–150) mm Hg. Thirty-eight percent (13/34) of children were incidentally diagnosed and 18% (6/34) presented with heart failure. Twenty-six (76%) children had main renal artery stenosis and 17 (50%) mid-aortic syndrome. Seventeen (50%) children showed intrarenal, six (18%) mesenteric, and three (9%) cerebrovascular involvement. Twenty patients underwent 45 percutaneous transluminal angioplasty procedures and seven children surgeries. In 44% of the 16 patients who underwent only percutaneous transluminal angioplasty blood pressure was normalized, 38% had improvement on same or decreased treatment and 19% showed no improvement. Complications were seen in 7.5% (5/66) of angiographies. In four of the seven (57%) children who underwent surgery blood pressure was normalized, two had improved (29%) and one unchanged (14%) blood pressure.Conclusion: In small children with renovascular hypertension below the age of 2 years, percutaneous transluminal angioplasty caused significant improvement in blood pressure with low complication profile. Surgery can be recommended where percutaneous transluminal angioplasty and medical treatments failed.What is Known:• Renovascular hypertension is diagnosed in all age groups from a few weeks of life until adulthood.• Both angioplasty and surgery are significantly more difficult to perform in small children and the published information on short and long-term outcome in these children is very scarce.What is New:• Children below the age of two years can safely and successfully undergo selective renal angiography and also safely be treated with angioplasty.• We here present a large group of babies and infants where angioplasty and in some cases surgery effectively and safely improved their blood pressure.