Dilatation Of Renal Artery Research Articles

Embolization of Giant Post-Traumatic Arteriovenous Renal Fistula using the Penumbra Occlusion Device

Purpose: Giant post-traumatic artero-venous renal fistula is a very rare condition, and the exclusion of renal perfusion is the principal risk of embolization. Aim of our presentation is to evaluate new materials and devices derivated by neuro-angio experience to treat the vascular arterio-venous renal fistula. Material and Methods: From march 2017t to december 2020 we have treated 3 post traumatic hight-flow artero-venous renal fistulas. In one case an aneurysmatic dilatation of renal artery was associated. All patients were previously and during follow-up evaluated by MDCTA and US-color-Doppler. POD Penumbra System plus, POD packing coil were used to treat arterio-venous renal fistula. Results: In all cases (3/3) complete arterio-venous renal fistula occlusion was obtained. Pod System and Pod packing coil were delivered with microcatheter directly in the arterial side of the arterio-venous renal fistula. The renal fuction and complete parenchymal preservation were obtained Conclusions: In our preliminary experience Penumbra System revealed to be a secure device for a complete exclusion of high-flow arterio-venous renal fistula and preserving renal perfusion.

Renal Artery Vasodilation May Be An Indicator of Successful Sympathetic Nerve Damage During Renal Denervation Procedure.

Autonomic nervous system plays a crucial role in maintaining and regulating vessel tension. Renal denervation (RDN) may induce renal artery vasodilation by damaging renal sympathetic fibers. We conducted this animal study to evaluate whether renal artery vasodilation could be a direct indicator of successful RDN. Twenty-eight Chinese Kunming dogs were randomly assigned into three groups and underwent RDN utilizing temperature-controlled catheter (group A, n = 11) or saline-irrigated catheter (group B, n = 11) or sham procedure (group C, n = 6). Renal angiography, blood pressure (BP) and renal artery vasodilation measurements were performed at baseline, 30-minute, 1-month, and 3-month after interventions. Plasma norepinephrine concentrations were tested at baseline and 3-month after intervention. Results showed that, in addition to significant BP reduction, RDN induced significant renal artery vasodilation. Correlation analyses showed that the induced renal artery vasodilation positively correlated with SBP reduction and plasma norepinephrine reduction over 3 months after ablation. Post hoc analyses showed that saline-irrigated catheter was superior to TC catheter in renal artery vasodilation, especially for the acute dilatation of renal artery at 30-minute after RDN. In conclusion, renal artery vasodilation, induced by RDN, may be a possible indicator of successful renal nerve damage and a predictor of blood pressure response to RDN.

Renal artery stenting in patients with uncontrolled hypertension: should we? And to whom?

In this issue of the Journal, Chrysant and colleagues evaluated the longer-term efficacy of renal artery stenting with respect to blood pressure (BP) control by analyzing the results of the Safety and Effectiveness Study of the Herculink Elite Renal Stent to Treat Renal Artery Stenosis (HERCULES) trial after 36 months of follow-up. 1 The HERCULES trial was a multicenter, single-arm trial of 202 patients with uncontrolled hypertension caused by atherosclerotic renovascular disease (ARVD) treated by percutaneous renal artery dilatation and renal stent placement. In the original HERCULES trial, the authors found that the absolute reduction in systolic BP (SBP) after 9 months was related to the severity of the baseline hypertension before intervention. In ARVD patients with preprocedure SBP >180 mm Hg and a postprocedure reduction in SBP, the mean reduction recorded at 9 months was 48 mm Hg, while patients with ARVD with a baseline SBP between 140 mm Hg and 160 mm Hg had a decrease of only 23 mm Hg in SBP at 9 months. In addition, this trial demonstrated excellent procedurerelated safety, with a 30-day composite safety endpoint rate of 1.5%. 2 Chrysant and colleagues further hypothesized that if the renal stent used in the initial HERCULES trial maintained renal artery patency over time, then the clinical benefit confirmed in the initial trial should be sustained over time. Based on this hypothesis, the

Loss of Tubuloglomerular Feedback in Decompensated Liver Cirrhosis: Physiopathological Implications

In healthy subjects, arterial pressure reduction or renal ischemia produces renal artery dilatation through autoregulation and tubuloglomerular feedback (TuGF). Patients with decompensated cirrhosis have reduced kidney perfusion pressure but show renal vasoconstriction instead of autoregulation-mediated vasodilation. This study investigates the consequences of kidney autoregulation loss on renal perfusion, glomerular filtration rate, and tubular handling of electrolytes in both compensated and ascitic nonazotemic cirrhotic patients. Forty-two consecutive patients with diuretic-free liver cirrhosis (32 with preascitic and 10 with ascitic disease) and 10 controls were submitted to the following determinations: (a) basal plasma renin activity and aldosterone levels; (b) endogenous dopaminergic activity measured as incremental aldosterone responses during metoclopramide administration; and (c) renal clearances of sodium, potassium, inulin, para-aminohippurate and lithium. Compared with the other groups, ascitic patients showed lower renal plasma flow (P < 0.01) and lithium clearance (P < 0.05), a higher filtration fraction (P < 0.01), and secondary aldosteronism. Controls and preascitic patients displayed tubuloglomerular feedback (the mechanism increasing the glomerular filtration rate when a reduced sodium load reaches the distal tubule), as demonstrated by negative correlations between fractional excretion of lithium (an expression of fractional delivery of sodium to the distal nephron) and glomerular filtration rate (respectively, r = -0.73, P < 0.03, and r = -0.48, P < 0.01). Conversely, patients with ascites showed a positive correlation between lithium fractional excretion and glomerular filtration rate (r = 0.64, P < 0.05). Reduction in renal perfusion, increased filtration fraction, and TuGF derangement, as found in decompensated patients, are indicative of prevalent postglomerular arteriolar vasoconstriction, with ensuing stimulation of proximal tubular sodium reabsorption.

Renal artery dilatation by stenting in patients with renal artery stenosis

Renal artery dilatation by stenting in patients with renal artery stenosis

The Kissing Balloons Technique

Whereas dilatation of a single stenosis of the main renal artery is a routine intervention, a narrowing of the renal artery at its bifurcation extending into the branch arteries poses a more complex problem. The procedural risks of renal artery dilatation are compounded by the danger of occlusion of one of the branch arteries during maneuvers to dilate the other. Long-term results of surgical vascular reconstruction at a renal artery bifurcation are not satisfactory. Untreated, these stenoses lead to intractable hypertension and impairment or loss of renal function. We present a patient with hypertension and impaired function of the right kidney on account of a renal arterial bifurcation stenosis. Using a bilateral transfemoral arterial approach 2 balloon catheters were simultaneously placed into the origins of the renal artery branches and both arteries were successfully dilated by the kissing balloons technique. This method provides an elegant alternative to difficult surgery to save an endangered kidney.

Results of Renal Artery Balloon Angioplasty Limit its Indications

Abstract Percutaneous transluminal balloon angioplasty (PTA) of 83 renal artery lesions in 55 patients was done because of renal failure in eight patients, hypertension in 35, renal failure and hypertension in 11, and polycythemia in one patient. Early results in 38 patients with arteriosclerosis showed five (13%) were worse and 13 (34%) were unchanged. Twenty patients (53%) with arteriosclerosis were initially cured or improved; however, seven of these patients had recurrence in 4 to 48 months. Ultimately, only 13 of 38 patients with arteriosclerosis (34%) were cured or improved (mean follow-up 22 months). Nine patients with fibromuscular dysplasia required 17 dilatations of arteries (three bilateral and five repeat), resulting in eight patients (89%) who were cured or improved. Selection of patients with hypertension by medical failure while receiving three or more hypertension medications or by lateralizing renal vein renin values yielded benefit in 17 of 26 patients (65%). Five of six patients with transplant stenosis of the renal artery and hypertension were cured or improved at mean follow-up of 18 months. Overall technical results of 83 artery dilatations were as follows: good, 58 (69%); fair, 10 (12%); poor or unsatisfactory, 16 (19%); these were judged with a blinded radiologic review. No patient suffered main renal artery thrombosis. There were 16 patients with complications of dilatation (morbidity rate of 29%). Nine patients subsequently had renal artery surgery from the same day to 64 days later with good results in all patients except one. We conclude that transluminal renal artery dilatation is a technique that should be restricted to use in patients with fibromuscular dysplasia, transplant stenosis, and very few arteriosclerotic lesions. (J VASC SURG 1988;8:300-6.)

Results of renal artery balloon angioplasty limit its indications

Percutaneous transluminal balloon angioplasty (PTA) of 83 renal artery lesions in 55 patients was done because of renal failure in eight patients, hypertension in 35, renal failure and hypertension in 11, and polycythemia in one patient. Early results in 38 patients with arteriosclerosis showed five (13%) were worse and 13 (34%) were unchanged. Twenty patients (53%) with arteriosclerosis were initially cured or improved; however, seven of these patients had recurrence in 4 to 48 months. Ultimately, only 13 of 38 patients with arteriosclerosis (34%) were cured or improved (mean follow-up 22 months). Nine patients with fibromuscular dysplasia required 17 dilatations of arteries (three bilateral and five repeat), resulting in eight patients (89%) who were cured or improved. Selection of patients with hypertension by medical failure while receiving three or more hypertension medications or by lateralizing renal vein renin values yielded benefit in 17 of 26 patients (65%). Five of six patients with transplant stenosis of the renal artery and hypertension were cured or improved at mean follow-up of 18 months. Overall technical results of 83 artery dilatations were as follows: good, 58 (69%); fair, 10 (12%); poor or unsatisfactory, 16 (19%); these were judged with a blinded radiologic review. No patient suffered main renal artery thrombosis. There were 16 patients with complications of dilatation (morbidity rate of 29%). Nine patients subsequently had renal artery surgery from the same day to 64 days later with good results in all patients except one. We conclude that transluminal renal artery dilatation is a technique that should be restricted to use in patients with fibromuscular dysplasia, transplant stenosis, and very few arteriosclerotic lesions.

Complications in percutaneous transluminal dilatation of renal arteries.

We propose a classification of the complications in renal artery percutaneous transluminal angioplasty (PTA) according to their severity and their direct or indirect relationship to PTA. Minor complications are reversible within the normal recovery period after PTA, while major complications are irreversible or reversible but necessitate extended hospitalization or surgery. The following complications are reported in the literature as being directly related to PTA: hemorrhage at the puncture site, hemorrhage from renal or access artery perforation or rupture, occlusive or nonocclusive dissection of the renal or access arteries, renal artery thrombosis, renal artery spasm or embolism leading to segmental renal infarction, peripheral artery embolisation, and balloon rupture complications. The indirectly related complications include transient or irreversible renal insufficiency, contrast media hypersensitivity, pressure-drop-related cerebral or myocardial ischemia, and anticoagulation-related hemorrhage infections. In our own series of 105 PTA in 80 patients, complications occurred in 11% of which 4% were major, 1% indirectly related to PTA leading to death. In the reports available, the rate of major complication ranges between 3 and 10%, and the death rate around 1%.

Percutaneous transluminal renal artery dilatation for fibromuscular dysplasia with special reference to the acute effects on the renin-angiotensin-aldosterone system and blood pressure.

Twelve hypertensive patients (mean age 46.6 years, range 37-55 years) with fibromuscular dysplasia of the renal artery were treated with percutaneous transluminal renal angioplasty (PTRA) and the effects on the renin-angiotensin-aldosterone system and blood pressure were studied in the acute phase. The technical result of PTRA measured by angiography and reduction of PRA and aldosterone excretion was satisfactory in 11 patients. In spite of this only three patients were cured of their hypertension and two patients were improved at six months follow-up. During PTRA an immediate rise in plasma renin activity was noted in patients without beta-receptor blockade but not in patients treated with beta-receptor blocking agents suggesting a beta-receptor mediated release. This peak in renin release was not accompanied by any rise in systemic blood pressure. The blood pressure response in the acute phase did not show any regular pattern. We conclude that PTRA can serve as a model for studying effects of 'clamping' and 'declamping' of the renal artery in man.

Percutaneous transluminal angioplasty: experience in balloon dilatation of peripheral coronary and renal arteries.

Balloon catheter dilatation (percutaneous transluminal angioplasty) of peripheral, coronary and renal arteries is reported, comprising 80 arteries in 62 patients. The clinical success rate was 79% complete relief of symptoms, 9% partial relief. Recurrence was 7% in a follow-up period of one month to 20 months, mean 6 months. There was a 6% incidence of complications requiring surgery. This and other recent reports indicate that, provided the current high patency rate continues on long-term follow-up, percutaneous angioplasty has a major contribution to make in the management of arterial disease. Advantages include relatively low morbidity and cost, and short rehabilitation time. It can be repeated if necessary, and in the event of failure surgical treatment is seldom precluded. Close co-operation between disciplines is essential for optimum case selection and if complications arise.

Transluminal renal artery dilatation in hypertension: technique, results, and complications in 60 cases.

Transluminal renal artery dilatation in hypertension: technique, results, and complications in 60 cases.

The axillary approach to percutaneous renal artery dilatation.

The axillary approach to percutaneous transluminal angioplasty of the renal arteries is described. This technique simplifies renal dilatation in patients with severe atherosclerotic disease in the vessels distal to the renal arteries.

Treatment of Renovascular Hypertension by Transluminal Renal Artery Dilatation

Excerpt Percutaneous transluminal angioplasty has proved valuable in the treatment of atherosclerotic occlusive disease of femoral and iliac arteries (1, 2). The application of this technique has r...