Renal Artery Rupture Research Articles

Treatments for pathogen infection rescued 2 patients with renal artery rupture after kidney transplantation: A case report.

Renal artery rupture due to allograft infection, especially by fungi, is a serious clinical complication that can occur after kidney transplantation, and may lead to graft loss and death. Two kidney recipients from China who developed renal artery rupture at our hospital on 5 days (47-year-old female) and 45 days (39-year-old male) after surgery. The male had immunoglobulin A nephropathy as a primary disease, and experienced a postoperative attack of vascular rejection and mixed infection by Mucor and bacteria. The female had chronic glomerulonephritis as a primary disease, and experienced renal artery rupture near the anastomosis site with infection by fungi and other pathogens. The male received resection of the implanted kidney and antibiotic therapy with intravenous vancomycin (0.5 g, 2 days) and amphotericin B (530 mg in 33 days). The female received replacing the segment of renal arterial and internal iliac artery by saphenous vein, as well as antibiotic therapy with amphotericin B (320 mg in 8 days). The male was recovered and received a second transplantation, while the female was discharged on postoperative day 19. In both patients, prompt surgery and aggressive treatment with an antifungal drug (amphotericin B) and antidrugs led to successful rescue.

Diagnostic and therapeutic strategies for vascular complications after renal transplantation: a single-center experience in 2,304 renal transplantations.

Vascular complications after renal transplantation are one of the serious surgical complications, which can affect the transplantation outcome and even endanger life if not treated properly. We performed a retrospective analysis of the 2,304 renal transplantations procedures completed between the period of Jan., 2015 and Jan., 2022, which consisted of 1,658 male patients and 646 female patients. Among the above cases, there were 54 cases of vascular complications after renal transplantation, the incidence of vascular complications in our study was 2.34% (54/2,304), the most common vascular complication was transplanted renal artery stenosis (TRAS, n = 36), followed by external iliac artery dissection (n = 5), renal artery rupture (n = 4), renal vein thrombosis (n = 3), renal artery thrombosis (n = 2), renal artery dissection (n = 1), renal artery pseudoaneurysm (n = 1), and internal iliac artery pseudoaneurysm (n = 1), and renal artery kinking (n = 1). 40 patients were treated by percutaneous transluminal angioplasty (PTA), including 3 balloon catheter dilatation and 37 endovascular stentings, and 14 underwent open surgery. Eventually, 9 patients had graft nephrectomy, resulting in an overall treatment rate of 81.5%. Most vascular complications can be treated satisfactorily with PTA. However, the overall treatment of renal artery rupture, thrombosis, renal artery kinking, and other complications is poor, and the rate of transplanted renal loss is high.

Early Experience of Inner Branch Retrograde Cannulation With E-nside Branch Stent Graft for Thoracoabdominal Aortic Aneurysms.

The aim of our study is to investigate the feasibility of retrograde cannulation using devices with inner branches (IB) for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). A retrospective analysis using IB configuration with retrograde cannulation was carried out on TAAAs patients undergoing endovascular treatment. Seven patients underwent IB endovascular treatment with retrograde cannulation between September 2020 and November 2021. The mean age was 80.4 years and 4 patients were male. A total of 26 of 28 target vessels were cannulated by retrograde access with a technical success of 93% (2 of 26 target vessels). Two intra-procedural complications were observed (1 renal artery dissection and 1 collateral renal artery rupture). In total, 26 of 28 treated vessels were retrograde cannulated with a technical success of 93%. A total of 39 stent bridges were used (all Viabahn VBX devices). The mean duration of the procedure was 321±102 minutes, and the mean scan time was 134±62 minutes. Mortality at 30 days was observed in 1 case. During the follow-up, 1 stent bridge occlusion was observed without the need for reintervention. Retrograde cannulation can also be successfully performed in the case of inner branches. In inner branched cases, retrograde cannulation should be taken into consideration in particular cases or it could become the option of choice. Dedicated endovascular material available such as steerable catheters and latest generation covered stents is fundamental for the success of the treatment.

A fatal complication during percutaneous nephrolithotomy: a renal artery rupture

A fatal complication during percutaneous nephrolithotomy: a renal artery rupture

A Rare Case of Fibromuscular Dysplasia with Postpartum Renal Artery Rupture in a Non-Hypertensive Woman

Fibromuscular dysplasia (FMD) of the renal artery is a non-atherosclerotic, non-inflammatory vascular disease that causes stenosis, aneurysm, dissection, and occlusion of the vessel. We report a rare case of a postpartum FMD patient who presented with spontaneous acute perirenal hematoma due to renal artery aneurysm rupture after cesarean section. The 40-year-old patient presented with sudden onset of abdominal pain 2 days after an elective cesarean section performed at full gestational term. A computed tomography scan of the abdomen revealed perirenal hematomas with signs of FMD in both renal arteries. The bleeding was successfully controlled by transcatheter arterial embolization. Short-term continuous renal replacement therapy was performed until her renal function recovered. FMD of the renal artery is rare in pregnant patients. Additionally, aneurysm rupture can be life threatening and requires immediate medical attention and prompt management.

Post-traumatic renal artery thrombosis secondary to blunt abdominal trauma: a rare case report

Background: Blunt abdominal trauma is one of the leading causes of morbidity and mortality among populations worldwide. However, renal artery injury due to blunt abdominal trauma is a rare occurrence. In this case, a patient who suffered multiple trauma was found in the emergency department, including blunt abdominal trauma, after a motor vehicle accident.Case report: A 13-year-old boy with multiple trauma was referred to our emergency department, with the primary consideration being to lose consciousness 3 hours before admission due to a traffic accident. After receiving examination, there was no evidence of abdominal bruising, whereas the results of the head CT scan show epidural hemorrhage. After four days of treatment, the urea and creatinine serum levels increased, abdominal CT scan shows right renal infarction suggestive of right renal arterial rupture. The patient was diagnosed with a moderate head injury and right renal trauma AAST grade IV. The patient was referred to the interventional radiology unit. The endovascular revascularization techniques were performed with renal artery stent placement and vasodilator (nitroglycerin) flush into the renal artery before stent placement. Renal artery stenting placement performed on main right renal artery demonstrates the absence of intraluminal defects and substantially blood flow was established, abdomen CT Scan shows an enhancement on right renal parenchyma which mean right kidney vascularization appears to be improved with the return of glomerular filtration rate to normal value at the time the patient was discharged.Conclusion: Traumatic renal artery thrombosis is a rare occurrence with devastating consequences if any imaging is missed. Endovascular therapy plays a significant role in the treatment of renal artery thrombosis with a better prognosis.

腎動脈破裂で発症し，次世代シークエンサーを用いて診断に至った血管型エーラス・ダンロス症候群の1例

腎動脈破裂で発症し，次世代シークエンサーを用いて診断に至った血管型エーラス・ダンロス症候群の1例

Spontaneous Rupture of Transplant Renal Artery and External Iliac Artery Caused by Corynebacterium striatum.

Surgical InfectionsVol. 22, No. 5 Letters to the EditorSpontaneous Rupture of Transplant Renal Artery and External Iliac Artery Caused by Corynebacterium striatumZhiping Xia, Guizhu Peng, and Qifa YeZhiping XiaZhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases and Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, People's Republic of China.Search for more papers by this author, Guizhu PengZhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases and Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, People's Republic of China.Search for more papers by this author, and Qifa YeAddress correspondence to: Dr. Qifa Ye, Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, No. 169 of Donghu Road of Wuchang District, Wuhan 430071, Hubei Province, People's Republic of China E-mail Address: yqf_china@163.comZhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases and Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan Hubei, People's Republic of China.Search for more papers by this authorPublished Online:18 May 2021https://doi.org/10.1089/sur.2020.280AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Spontaneous Rupture of Transplant Renal Artery and External Iliac Artery Caused by Corynebacterium striatum." Surgical Infections, 22(5), pp. 585–586FiguresReferencesRelatedDetails Volume 22Issue 5Jun 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Zhiping Xia, Guizhu Peng, and Qifa Ye.Spontaneous Rupture of Transplant Renal Artery and External Iliac Artery Caused by Corynebacterium striatum.Surgical Infections.Jun 2021.585-586.http://doi.org/10.1089/sur.2020.280Published in Volume: 22 Issue 5: May 18, 2021Online Ahead of Print:August 5, 2020PDF download

PERCUTANEOUS CUTTING BALLOON ANGIOPLASTY FOR TREATMENT OF RESISTANT RENAL ARTERY STENOSIS IN PEDIATRIC PATIENTS

Objective: Percutaneous transluminal renal angioplasty (PTRA) without stenting is the recommended treatment for hypertensive children with renal artery stenosis (RAS). However not infrequently RAS is resistant to PTRA or recurs after the procedure. To circumvent PTRA limitations percutaneous cutting balloon angioplasty (PCBA) has been used occasionally but caution is warranted because of the risk of rupture or dissection of renal artery. However the technical improvements in PCBA prompted us to exploit this procedure in children with severe hypertension and RAS resistant to PTRA. Design and method: Thirteen children (10 males, mean age 7.9 ± 3.3 y at operation) with resistant RAS (bilateral in 5) underwent PCBA. In 10 patients (pts) RAS was due to fibromuscular dysplasia, in 2 due to NF1 and in 1 to William's Syndrome. In 3 pts in addition to PCBA stenting of the aorta (1pt) and of RAS (3 pts) was also applied. Office blood pressure (BP), 24 hours ambulatory pressure monitoring (ABPM) (4/13pts), renal function and ultrasound (US) of renal arteries were evaluated before and after PCBA after a mean follow up of 21 ± 17.4 months. Results: PCBA achieved dilation of RAS in all cases. In one single case partial renal artery dissection occurred that did not require stent application. At follow-up no restenosis was found at US investigation in the 15 lesions who didn’t need stenting of RAS and in 1/3 stented RAS. Hypertension was cured in 7 pts and improved in the remaining 6 pts. After PCBA mean office systolic and diastolic BP (SBP and DBP mmHg) were reduced respectively from 141 ± 19 to 122 ± 12 and from 87 ± 10.to 69 ± 11 (p < 0.05 for both). With ABPM, SBP and DBP decreased respectively from 145 ± 3 to 130 ± 3 and from 88 ± 14 to 79 ± 16 (p < 0.05 for both). The antihypertensive agents assumed by pts with improved BP decreased from a mean of 2.7 to 0.6 per day. No significant changes were found in renal function after PCBA. Conclusions: In our experience PCBA appears a safe and effective treatment of RAS resistant to PTRA.

Ruptured renal artery aneurysm in pregnancy and puerperium: literature review of 53 cases.

To summarize and define the most appropriate diagnostic methods and therapeutic options for ruptured renal artery aneurysms in pregnancy based on rarely published data. Literature searches of English-, German-, Spanish-, and Italian-language articles were performed in PubMed (1946-2018), PubMed Central (1900-2018) and Google Scholar. The search terms included renal artery aneurysm, renal artery rupture, pregnancy, puerperium, nierenarterienaneurysma, schwangerschaft, wochenbett, aneurisma de la arteria renal, el embarazo, puerperio, aneurisma dell'arteria renale and gravidanza. Additional studies were identified by reviewing reference lists of retrieved studies. Fifty-three cases were collected. The average maternal age was 31 ± 6years; 71.4% were multiparous and significantly older than primiparas. The majority presented in the third trimester (62.3%), followed by second (20.7%) and the first (5.7%), while 11.3% presented postpartum. All postpartum patients presented during the first week postpartum and 50% during the first 24h postpartum. Parity was not associated with the trimester of presentation. The left renal artery was affected slightly more frequently (58.5% vs. 41.5%). There were no differences in the affected side according to trimester of presentation, including postpartum. 25 out of 53 cases underwent ipsilateral nephrectomy (47.1%) and 18 underwent aneurysm repair or coil embolization (34.0%). There was no difference in maternal (25.8%) vs. 4 (18.1%) and fetal mortality according to the side of rupture. There were no differences in the distribution of maternal or fetal mortality frequency according to the trimester of presentation. The clinical presentation is easily confused with more common conditions and time to diagnosis is often delayed. Diagnostic delay is associated with high maternal and fetal mortality. Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with acute and severe flank pain, especially if followed by a drop in blood pressure. Early diagnosis and immediate intervention are important for achieving better maternal and fetal outcomes. There are several methods of managing asymptomatic or ruptured renal artery aneurysm during pregnancy although no established guidelines exist.

Epidemiology of carbapenem-resistant Klebsiella pneumoniae bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis

BackgroundAlthough the high mortality rates have been extensively reported worldwide, few studies have investigated the epidemiology of CRKP-BSIs in the early stage after kidney transplantation (KTx) from donation after cardiac death (DCD). We sought to describe the epidemiological and clinical characteristics of cases of carbapenem resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) in kidney transplantation recipients (KTRs) from DCD in our hospital.MethodsA retrospective analysis of clinical data of CRKP-BSIs in KTRs admitted to a Chinese hospital in Beijing, China, between January 1, 2012 and December 31, 2016 was performed. The annual percentage of patients with CRKP, the annual number of total KTRs and KTRs from DCD were determined. The genetic relatedness of the strains was determined by polymerase chain reaction and pulse field gel electrophoresis (PFGE).ResultsDuring the study period, there were total 947 KTRs in our hospital, including 275 KTRs from DCD. Five incidences of CRKP-BSIs in KTRs were identified, and two of them (Case 1,3) from the same foreign hospital. The incidence of CRKP-BSIs in the early stage (within 3 months) following kidney transplantation (KTx) from DCD was about 1.1% (3/275). In Case 1–3 and 5, the rupture of renal transplant artery was presented on the 40th, 16th, 43th and 74th day after KTx, and in Case 4, the thrombus of renal transplant artery was presented on the 13th day after KTx. Three cases (Case 1,2,5) occurring pneumothorax on the 45th, 51th and 32th day after KTx. Four cases (Case 1–4) received the excision of the transplanted kidney for the treatment. Polymerase chain reaction showed the bands for case 2 were distinctive from other cases. Pulse field gel electrophoresis showed mainly three clusters of the bands for all the isolates.ConclusionsDuring the study period, we observed an increase in the occurrence of CRKP-BSIs among KTRs from DCD in our hospital. We demonstrated that rupture/thrombus of the renal transplant artery was associated with CRKP-BSI in the early stage after KTx from DCD. Albeit the low incidence of CRKP-BSI (1.1%) after KTx from DCD, the high mortality (4/5) had been observed from the prognosis of the patients. Thorough surveillance of DCD donors, early identification of CRKP-BSI, necessary preventative measurements and use of appropriate treatments should be the strategy for CRKP-BSI in the early stage after KTx from DCD.

Vascular complications in two kidney allograft recipients secondary to different fungal infections from the same donor: A case report

Donor-derived fungal infection is a significant complication in renal transplant recipients that can be associated with serious and sometimes deadly consequences. This article reports two patients who develop severe vascular complications secondary to different fungal infections from the same donor. One patient is diagnosed with renal artery aneurysm that is caused by Candida parapsilosis, and the graft has to be removed. The other patient has developed renal arterial rupture that is attributed to Cryptococcus. Although the affected renal artery is excised and the remaining artery is anastomosed, the function of the graft is not restored. Early recognition and prompt management of vascular complications caused by fungal infections are crucial for favorable outcomes.

Case Report on Ruptured Renal Artery Aneurysm

Renal aneurysms are a rare entity with an incidence of 0.09% of the population. They are often asymptomatic and frequently discovered incidentally during abdominal imaging for unrelated causes. Rupture of renal artery aneurysms is a surgical emergency, very often lethal. Swift diagnosis is crucial and is made by ultrasound and abdominal MDCT. We report the case of a renal artery rupture in a 58 year-old man who arrived in the emergency department with left flank pain of sudden onset followed by a hypovolemic shock. MDCT scan showed the rupture of an aneurysm of the left renal artery associated with a retroperitoneal hematoma. It is a life-threatening situation in case of delayed diagnosis. In our case, prompt imaging and diagnosis led to conservative treatment and nephrectomy was avoided.

Operative and Midterm Outcomes of the Fenestrated Anaconda Stent-Graft in the Endovascular Treatment of Juxtarenal, Suprarenal, and Type IV Thoracoabdominal Aortic Aneurysms

Purpose: To report operative and midterm outcomes of fenestrated endovascular aneurysm repair (FEVAR) with the Anaconda device. Methods: A retrospective analysis was conducted of 39 consecutive patients (median age 74 years; 36 men) treated with the fenestrated Anaconda stent-graft between July 2011 and December 2015 at a single center. Indications for FEVAR were abdominal aortic aneurysms (AAAs) with neck anatomy unsuitable for a standard stent-graft. Median infrarenal neck length was 4 mm (range 0–9). Four (10%) patients presented with type IV thoracoabdominal aortic aneurysm (TAAA), 12 (31%) with suprarenal aneurysms, and 23 (59%) with juxtarenal aneurysms. Four (10%) patients had previous infrarenal aortic repair. Five (13%) patients had an infrarenal neck angulation >60°. A total of 106 fenestrations were incorporated into the stent-grafts (73 renal arteries, 25 superior mesenteric arteries, and 8 celiac trunks). Technical success, perioperative and midterm mortality and morbidity, target vessel patency, endoleaks, and reinterventions were documented. Results: Technical success was 95% (37/39). Three (8%) patients died in-hospital from mesenteric embolism in 2 and renal artery rupture with consequent multiorgan failure in 1. Two (5%) patients suffered an intraoperative embolic stroke. During a median follow-up of 33 months (range 4–55), adjunctive maneuvers were performed in 9 (23%) patients, including reintervention for type II endoleak with enlarged aneurysm sac in 2 (5%). Four additional patients died of causes unrelated to the aortic pathology (overall mortality 18%). In 34 (94%) of the 36 patients seen in follow-up, aneurysm sac size was stable or decreased. Target vessel stent patency was 99% (95/96). Conclusion: FEVAR with the Anaconda device delivers satisfactory short-term technical and clinical success rates in patients with juxtarenal, suprarenal, and type IV TAAA. Midterm efficacy and durability with respect to aneurysm sac regression and target vessel patency appear very good. Overall mortality and the need for reintervention were significant in this patient cohort.

Renal artery aneurysms

Renal artery aneurysms are rare in the general population, although the true incidence and natural history remain elusive. Controversy over criteria for repair persists across decades. Indications for repair presently include aneurysm size >2 cm, female gender within childbearing age, symptoms like pain and hematuria, medically refractory hypertension including that associated with functionally important renal artery stenosis, thromboembolism, dissection, and rupture. Conventional surgical reconstruction options are variable and continue to offer technically sound and durable results. Endovascular therapies with novel devices also offer technical success with few major adverse events, and are increasingly employed as indications for intervention broaden. This review summarizes the accumulated evidence on true renal artery aneurysms with a particular focus on contemporary treatment criteria, natural history, options for repair and outcomes following such.

Contrast‐Enhanced Sonographically Guided Percutaneous 915‐MHz Microwave Ablation Therapy Compared to Local Hemostatic Drug Injection in a Renal Artery Injury Model

The purpose of this study was to show the contrast-enhanced sonographic features of various levels of renal artery rupture and to validate the therapeutic effects of percutaneous 915-MHz microwave ablation compared to hemostatic drug injection (batroxobin) using an in vivo canine renal artery injury model. Three renal artery hemorrhage models (A, diameter <1 mm, subcapsular artery; B, diameter 1-2 mm, interlobar artery; and C, diameter 2-3 mm, segmental artery) were created in 24 canines for this study. Contrast-enhanced sonography was used to show the bleeding features and guide hemostatic therapies using 915-MHz microwave ablation and local batroxobin injection. Success rates were assessed according to amounts of bleeding, times required for hemostatic action, and volumes of fluid infusion required using pathologic examination as a reference standard. Contrast-enhanced sonography clearly showed renal artery ruptures with active bleeding at various levels and degrees and was very useful to make diagnoses and guide therapies. The success rate in the microwave treatment group was higher than that in the drug injection group (except group A; P< .05). The time required for hemostasis and the volume of fluid infusion required in the microwave group were notably less than those in the drug injection group (P < .05). Contrast-enhanced sonography is a useful imaging method for assessing renal vessel injury and guide interventional therapies. Contrast-enhanced sonographically guided percutaneous 915-MHz microwave ablation is a preferred hemostatic technique for treatment of renal artery injury, with greater effectiveness and less tissue damage compared to local drug injection.

Transarterial embolization for serious renal hemorrhage following renal biopsy

The goal of this study is to evaluate the feasibility and efficacy of percutaneous transarterial embolization for the treatment of serious renal hemorrhage after renal biopsy. Nine patients with renal hemorrhage had frank pain and gross hematuria as main symptoms after renal biopsy. Intrarenal arterial injuries and perinephric hematoma were confirmed by angiography in all cases. The arterial injuries led to two types of renal hemorrhage, Type I: severe renal injure or intrarenal renal artery rupture (n=5), with contrast medium spilling out of the artery and spreading into renal pelvis or kidney capsule in angiography; Type II, pseudo aneurysm or potential risk of intrarenal artery injure (n=4), where contrast medium that spilled out of intraartery was retained in the parenchyma as little spots less than 5 mm in diameter in angiography. Transcatheter superselective intrarenal artery embolization was performed with coils or microcoils (Type I intrarenal artery injure) and polyvinyl alcohol particles (Type II injure). The intrarenal arterial injuries were occluded successfully in all patients. Light or mild back or abdominal pain in the side of the embolized kidney was found in three patients following embolization procedures and disappeared 3 days later. Serum creatinine and perinephric hematoma were stable, and gross hematuresis stopped immediately (n=4) or 3-5 days (n=3) after embolization. In conclusions, transcatheter superselective intrarenal artery embolization as a minimally invasive therapy is safe and effective for treatment of serious renal hemorrhage following percutaneous renal biopsy.

Renal artery rupture during complicated recovery from angioplasty to treat renal stenosis.

Renal artery rupture during complicated recovery from angioplasty to treat renal stenosis.

Consecutive Spontaneous Rupture of the Lower Pole Renal Artery and Main Renal Artery Due to Type 1 Neurofibromatosis

We report on a 37-year-old man suffering from type 1 neurofibromatosis with spontaneous rupture of a lower pole artery of the right kidney. Two renal arteries with aneurysmal alterations were identified at angiography. We did not coil the lower pole artery because active bleeding had stopped. Eleven days later, the patient suffered a further spontaneous rupture to the right main renal artery, and nephrectomy was unavoidable. His recovery was rapid and unremarkable.

Renal artery rupture following cutting balloon angioplasty for fibromuscular dysplasia: a case report.

Angioplasty with the use of cutting balloons has been suggested by some case reports and small series for the treatment of renal artery stenoses that are resistant to conventional balloon catheters. Based on this limited experience, the use of this technology has been suggested as safe. Herein, we report a renal artery rupture following angioplasty with a cutting balloon. The complication was salvaged with a stent graft. A 30-year-old white female patient with resistant hypertension caused by a severe renal artery stenosis attributed to fibromuscular dysplasia, was submitted to conventional balloon angioplasty without success. Dilatation of the lesion with a cutting balloon resulted in arterial rupture, with concomitant retroperitoneal hematoma. Cutting balloon angioplasty of renal artery lesions resistant to conventional balloon angioplasty should not be considered as safe as previously thought. When proceeding with such a procedure, a stent graft should be available for immediate use.