Renal Artery Rupture Research Articles

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

IntroductionAngioplasty 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.Case presentationA 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.ConclusionCutting 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.

Hepatic and Renal Artery Rupture Due to Aspergillus and Mucor Mixed Infection After Combined Liver and Kidney Transplantation: A Case Report

Fungal infection is a major cause of death in patients who undergo organ transplantation. The incidence of Aspergillus or Mucor infection is low compared with Candida species. We report a case in which Aspergillus and Mucor infected both the hepatic and renal arteries, leading the 2 arteries to rupture at the same time. The patient died 4 days after the second operation. We review the recent literature about this topic and explore the possible route of transmission in our patient. We also discuss the prophylactic methods for Aspergillus and Mucor infections.

Fatal haemorrhage due to extensive fragility of medium- and large-sized arteries and veins in a young patient with neurofibromatosis 1

Neurofibromatosis type 1 (NF1) is one of the most frequently inherited diseases. Vascular manifestations have been reported, mostly concerning stenosis of the renal artery or spontaneous rupture of single arteries. Also, venous aneurysms have been reported. We present clinical and pathological findings of a young patient with NF1 with lethal bleeding due to spontaneous rupture of a lumbal and renal artery. High fragility of several arteries as well as veins in the abdominal and pelvic arterial and venous system resulted in a destroyed vessel structure caused by invading neurogen fibres. In rare cases, NF1 is associated with a severe systemic vasculopathy concerning the arterial and venous vascular system.

Successful embolization of symptomatic renal artery aneurysm in solitary kidney

Renal artery aneurysms are uncommon vascular entities that occur in 0.09% to 0.3% of the general population. Renovascular hypertension, renal artery thrombosis, distal emboli, renal infarct, and rupture are some of its risks and complications.1 We present a case of a 57-year-old woman who presented with right loin pain. She had a history of left simple nephrectomy for a congenital anomaly 18 years previously. An ultrasound scan showed a 2-cm calcification in the renal area. Intravenous urography done subsequently was normal.

Prise en charge des traumatismes fermés de l’abdomen chez l’enfant

The aim of this study was to evaluate the radiological and therapeutic management of blunt abdominal trauma (BAT) in children, with retrospective data. Population and methods. – During 6 years (Nov 1995–Oct 2001), 92 children were hospitalised for BAT (mean age 9.5 years; 61.9% boys). Falls (45.6%) and motor vehicle accidents (43.5%) were the most frequent causes. The initial management included abdominal plain film X–ray and ultrasonography, and sometimes computed tomography (CT). The non-operative treatment was used, unless the patient was hemodynamically unstable or had hollow visceral injury, diaphragmatic rupture or renal artery rupture. Results. – Among 92 BAT, 52 were minor traumas and 40 were associated with one or several abdominal injuries. The sensitivity of ultrasonography to find hemoperitoneum and/or abdominal injuries was 80.3%, but the initial diagnosis of such lesions was accurate in 21 cases (52.5%) and delayed in 19 cases (47.5%), ranging from 1 to 7 days. In the delayed cases, the diagnosis was possible in nine cases with ultrasonography, in five cases with CT, but also with transaminase, amylase or lipase assays in two cases, and surgery in three cases. Twenty-nine children had a non-operative treatment and stayed in hospital about 12 days on average. Three children had surgery in emergency (two bowel perforations and one splenic rupture) and eight with delay (four renal ruptures, one associated splenic nodes, one pancreatic pseudocyst and one duodenal perforation). Only seven children (17.5%) required blood transfusion and no death occurred. Conclusion. – In a trauma centre, the management of abdominal injuries is possible with ultrasonography and its sensitivity is correct without increasing of morbidity and mortality. But, if in doubt, a CT must be performed because its sensitivity is better. Most of the time, the children can benefit from non-operative treatment.

Rupture of Renal Artery in a Patient with Behcet's Disease

Rupture of Renal Artery in a Patient with Behcet's Disease

Trasplante renal en pediatría: una década de experiencia multicéntrica

Paedriatric renal transplant is the treatment of choice in chronic renal failure (CRF), in that it permits the recuperation to differing degrees the severe consequences of uraemia, especially in terms of growth retardation. Objective: To evaluate the results of renal transplantation in 3 hospital centers during a 10 year period (1989-99). Patients and Methods: A retrospective study using a standard protocol carried out in the hospitals Exequiel Gonzalez Cortes, Luis Calvo Mackenna and San Juan de Dios between july 1989 and july 1999. 3 types of variables were analyzed; 1) demographic description, 2) growth between birth and the last year of follow-up, and 3) transplant related factors, especially immunosuppression, transplant complications and graft function during annual periods. Continuous variables were expressed as mean + SD, growth as Z score, renal function as 1/plasma creatinine, and together with the analysis of acute rejection in relation to live or cadaveric donor, were analyzed using Pearson´s Chi-squared. Renal function with regards to warm or cold ischaemia was evaluated using Student´s t-test, while Kaplan-Meier curves were used in the analysis of survival at 1,3, and 5 years both for patients and grafts. In all the tests a p value < 0.05 was considered significant. Results: 98 transplants were carried out on 92 patients, aged 10.9 + 3.2 years, range 2-17, the 3 most important causes of CRF were reflux nephropathy, renal dis- or hypoplasia and chronic glomerulonephritis. Growth showed a fall from a Z of -0.6 at birth, to -2.14 at the beginning of dialysis (p < 0.05) to -2.57 at the moment of transplant (p < 0.05). At 3 and 5yrs post transplant the Z values were -2.38 and -2.93 respectively. Actuarial patient survival rates at 1, 3 and 5yrs were 97.8, 95.2 and 92.6 for live donors and 92.6, 92.6, and 92.6 for cadaveric donors respectively. Graft survival for live donors was 89, 78 and 71% and cadaveric donors 84, 76 and 70% during the same time intervals. Reasons for graft failure were abandoning treatment 8 cases, renal vessel thrombosis 6, chronic rejection 4 and acute rejection 3 cases. 4 patients died, 2 from septicaemia, 1 from bronchopneumonia and 1 due to renal artery rupture. Conclusions: This report confirms that paedriatric renal transplant can be performed in Chile with an acceptable morbidity, a low mortality and with graft survivals similar to international centers.

Outpatient Percutaneous Transluminal Renal Artery Angioplasty: A Canadian Experience

The authors performed a retrospective study of their experience and complication rate while performing outpatient percutaneous transluminal renal artery angioplasty (PTRA) during a 5-year period. From July 1992 to July 1997, 87 PTRAs were performed. Of these, 62 PTRA procedures were performed on 53 outpatients. In total, 66 arteries were dilated in 62 PTRA sessions using standard, established techniques. During the same period, only 25 PTRAs were performed on inpatients. Angioplasties were performed on those patients with demonstrated renal artery stenosis and poorly controlled hypertension and/or renal failure. Patients chosen for PTRA were picked by a team that included a vascular surgeon, a nephrologist, and a radiologist. Patients who were deemed suitable for an outpatient procedure were recommended by a nephrologist. Radiological input was sought at that time. Specific guidelines were used to select these patients who were otherwise healthy, well-orientated, and able to respond to an emergency situation. None of the subjects had significant risk factors. All were accompanied by an adult for the first 24 hours and all lived no more than an hour's travel time from a hospital. All were stable on discharge and were seen within 24 hours by a nephrologist. The technical success rate, defined as a residual stenosis on imaging of less than 30% and/or by a pressure gradient of less than 10 mm Hg across the stenosis, was 85%. The early complication rate was 5.6%, including two patients who developed a localized hematoma. In all, four patients were admitted to the hospital rather than being discharged to home after an average of 4.2 hours of observation. The late complication rate was 3% and involved two patients. One patient, who reported pain after balloon deflation, was readmitted 6 hours after discharge with hypotension, and a diagnosis of renal artery rupture was confirmed with computed tomography. Another patient developed peripheral atheroemboli 20 days after the procedure. Outpatient PTRA can be performed on selected patients. In this study, late complications occurred in only 3% of patients. Early complications were readily recognized in 5.6% of patients, and these patients were admitted for observation after the procedure.

Surgery after failed percutaneous renal artery angioplasty

Purpose: This retrospective review describes the surgical management of 51 patients after failed percutaneous renal artery angioplasty (F-PTRA). Methods: From January 1987 through June 1998, 51 consecutive patients underwent surgical repair of either atherosclerotic (32 patients) or fibromuscular dysplastic (FMD; 19 patients) renovascular vascular disease after F-PTRA. These patients form the basis of this report. Surgical repair was performed for hypertension (29 patients with atherosclerosis: mean blood pressure, 205 ± 34/110 ± 23 mm Hg; 18 patients with FMD: mean blood pressure, 194 ± 24/118 ± 18 mm Hg) or ischemic nephropathy (20 patients with atherosclerosis: mean serum creatinine level, 2.0 ± 0.8 mg/dL; three patients with FMD: mean serum creatinine level, 2.0 ± 1.1 mg/dL). Emergency operation was required in four patients for acute renal artery thrombosis (one patient with atherosclerosis, one patient with FMD), renal artery rupture (one patient with atherosclerosis), or infected pseudoaneurysm (one patient with atherosclerosis). Operative management, blood pressure and renal function response to operation, and dialysis-free survival rate were examined and compared with 487 patients (441 patients with atherosclerosis, 46 patients with FMD) treated by operation alone. Results: Among the patients with atherosclerotic renovascular disease, there were three postoperative deaths (9.4%) after repair for F-PTRA. Secondary operative repair was associated with emergent repair or nephrectomy in 16% of cases, while more extensive renal artery exposure and more complex operative management was required in 50% of patients with atherosclerosis and 65% of patients with FMD repaired electively. Among the 28 operative survivors with hypertension and atherosclerotic renovascular disease, blood pressure benefit after F-PTRA was significantly lower when compared with patients with atherosclerosis who underwent treatment with operation only (57% vs 89%; P < .001). However, blood pressure benefit in the 19 patients with FMD did not differ (89% vs 96%). Among the 28 patients with atherosclerosis, preoperative estimated glomerular filtration rate (EGFR) as compared with postoperative EGFR was significantly increased (47.4 ± 4.2 mL/min/1.73m 2 vs 56.6 ± 5.1 mL/min/1.73m 2; P = .002). However, EGFR prior to PTRA was not significantly different from postoperative EGFR (51.6 ± 3.4 mL/min/1.73m 2 vs 56.6 ± 4.9 mL/min/1.73m 2; P = .121). As compared with patients with atherosclerosis who underwent treatment with operation alone, there was no difference in the dialysis-free survival rate. Conclusion: Operative repair after F-PTRA was altered in 59% of the patients with atherosclerosis and in 68% of patients with FMD. Blood pressure benefit for patients with FMD was unchanged after F-PTRA. However, the blood pressure benefit was significantly decreased among patients with atherosclerosis. Decreased EGFR after F-PTRA was recovered with operative renal artery repair. However, postoperative EGFR as compared with EGFR prior to PTRA was unchanged. Blood pressure and renal function response after F-PTRA for atherosclerotic renovascular disease warrants further study. (J Vasc Surg 1999;30:468-83.)

Stents in the Treatment of Renal Artery Stenosis: Long-Term Follow-up

Purpose: To evaluate the role of percutaneous stenting in the treatment of renal arterial lesions after failure of balloon angioplasty. Methods: Two hundred ten patients (139 males; mean age 67.7 ± 9.9 years, range 27 to 87) had 259 balloon-expandable stents (165 Palmaz and 94 Renal Bridge stents) implanted in 244 renal artery stenoses (171 ostial and 73 nonostial lesions). The patients were suffering from intractable hypertension (n = 210) and/or renal dysfunction (n = 48). The majority of the lesions (n = 234) were atheromatous in origin. Stents were implanted for suboptimal balloon dilation (n = 182, 75%), restenotic lesions (n = 27, 11%), or dissection (n = 9, 4%); 26 (11%) ostial lesions were stented primarily. Mean lesion length was 11.9 ± 4.4 mm (range 5 to 30) and mean percent stenosis was 81.9% ± 8.25% (range 70 to 100). Results: Immediate technical success was 99% (241 of 244). Three (1.2%) major complications included one intraprocedural stent thrombosis, one arterial perforation manifesting as a perirenal hematoma 24 hours after the procedure, and one renal arterial rupture. Follow-up over a mean 25.4 ± 22.8 months (range 1 to 96) in 185 eligible patients (209 arteries) found 24 cases of restenosis (11.4%). Primary and secondary patencies for all lesions at 60 months were 79% and 98%, respectively, with no significant differences between ostial and nonostial lesions or stent types. Hypertension was reversed in 35 (19%), improved in 112 (61%), and remained unchanged in 37 (20%). Renal function was improved in 29% (14 of 48), unchanged in 67% (32 of 48), and worse in 4% (2 of 48). Conclusions: Renal artery stenting is safe, effective, and may be an alternative to surgery, particularly in ostial lesions. Our experience shows reduction in the restenosis rate compared to conventional angioplasty. All ostial stenoses should be stented.

Splenorenal Bypass as an Emergency Procedure

The role of percutaneous transluminal angioplasty (PTA) in the management of renovascular hypertension is controversial when the cause is known to be atherosclerotic disease. The authors report a life-threatening complication of PTA, wherein renal artery rupture was successfully managed by emergency splenorenal bypass with preservation of the kidney function. Close cooperation between radiologists and the surgical team is a prerequisite for such interventional technique.

Spontaneous renal artery rupture in pregnancy

(1993). Spontaneous renal artery rupture in pregnancy. Journal of Obstetrics and Gynaecology: Vol. 13, No. 4, pp. 255-256.

Renal arterial rupture complicating transluminal angioplasty.

Renal arterial rupture complicating transluminal angioplasty.

Obstetrical problems in patients with Ehlers-Danlos syndrome type IV; a case report

The Ehlers-Danlos syndrome type IV is a heritable connective-tissue disorder characterized by thin translucent skin, pronounced bruising and scarring, and extreme tissue fragility. Obstetrical complications include premature rupture of membranes, rupture of bloodvessels and gravid uterus, tearing of perineum, vagina, urethra and bladder, requesting specific prophylactic and therapeutic measurements. Hereditary transmission is usually autosomal dominant with variable expression. Histological examination of skin biopsy and biochemical analysis of collagen proteins from skin fibroblast cultures confirm the clinical diagnosis. DNA studies offer the possibility of prenatal diagnosis in suitable families. The consecutive severe obstetrical complications of a woman with Ehlers-Danlos syndrome type IV are reported here. The patient died at age 33 years from renal artery rupture.

Renovascular Injuries from External Trauma: Diagnosis, Treatment, and Outcome

Blunt trauma of the deceleration or acceleration type is the most common cause of renal pedicle injuries comprising thrombosis or rupture of the main renal artery, branch renal artery, or the renal vein. There are no symptoms or signs specific to this injury, and hematuria is absent in one third of the cases. Severe multiple associated injuries are present in almost all cases, with a mortality rate of 44 per cent. Radiologic evaluation with intravenous urography shows nonappearance of the involved kidney. CT reveals nonenhancement of the kidney except for the periphery of the cortex from collateral circulation (rim sign), and renal arteriography shows occlusion of the renal artery or its branches. Despite immediate radiologic evaluation resulting in a short time from injury to diagnosis, most of the patients are not candidates for vascular repair owing to the high incidence of severe associated injuries, especially a second injury to the same kidney. Even with vascular repair, the function of the kidney is not restored to normal. Late hypertension is found in 50 per cent of patients with main renal artery thrombosis managed conservatively.

Rupture of the Renal Artery After Percutaneous Transluminal Angioplasty

To the Editor.— Olin and Wholey 1 described the pathology of renal artery injury after angioplasty, but did not emphasize prevention of morbidity and mortality in the broader clinical application of this technique. At another academic institution, I observed three deaths directly related to renal artery angioplasty, two from aortic thrombosis and one from renal artery rupture. Several lessons stand out: These complications occurred with skilled angiographers, but without prior surgical consultation and at a time inconvenient for the availability of an operating room. A qualified surgeon should be available to assess these patients for major complications such as aortic thrombosis, arterial dissection, or retroperitoneal hemorrhage. Angioplasty should never be performed simply because an anatomic lesion has been discovered. If the proper diagnostic studies have not been done and absolute indications for angioplasty do not exist, the procedure should be deferred. Repeated arterial catheterization for a secondary procedure under controlled

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%.

Isolated dissecting aneurysm of the renal artery

We report two cases of an unusual cause of the acute onset of hypertension, a spontaneous dissecting aneurysm localized to the renal artery. Also reviewed are 16 reported cases from the literature. The mean age of the 18 patients was 52 years. The majority of these patients were males (78 per cent). Hypertension was a presenting sign in 14 (78 per cent), but was not usually a preexisting feature. Loin pain, often severe, occurred in eleven patients (61 per cent), whereas gross hematuria was recorded only in two (11 per cent). The right renal artery was involved in ten cases (55 per cent), the left in three (17 per cent), and both in five cases (28 per cent). Atherosclerosis of the renal arteries and the aorta was absent in 69 per cent, and mild in 23 per cent. There has been no report of renal artery rupture; however, vascular occlusion occurs frequently. Medical and surgical approaches to the management of this phenomenon have been reported and are reviewed.

Renal artery rupture in a pregnant woman with neurofibromatosis.

Renal artery rupture in a pregnant woman with neurofibromatosis.

Rupture of the Right Renal Artery and Death

Rupture of the Right Renal Artery and Death