Segmental Branches Of Renal Artery Research Articles

A 3-YEAR DURABILITY OF POWERFUL BLOOD PRESSURE LOWERING EFFECT OF DISTAL RENAL DENERVATION

Objective: To evaluate efficacy and safety of anatomically optimized distal renal denervation (RDN) in segmental branches of renal artery. Design and method: We performed a double blind, randomized control study of the efficacy and safety of distal RDN versus conventional main trunk treatment in patients with true resistant hypertension (NCT02667912) with 3 year follow-up period. The efficacy of the RDN was evaluated by changes in ambulatory and office BP at 6, 12 and 36 month. The safety was assessed by a number of procedure-related adverse events, changes in the 24-h protein excretion, serum creatinine and eGFR during the same time periods. Results: Of 55 randomized patients who undergone RDN (28 - distal denervation vs 27 - main trunk treatment) 51 completed 6 month (27 vs 24), 47 - 12 month (23 vs 24), and 39 - 36 month follow-up (21 vs 18). There was a powerful significant decrease in 24-h mean ambulatory systolic BP at 6 month after distal RDN that was, also, maintained throughout the follow-up, and remained statistically significant at the end of the study, -21.1 (95% CI -28.9;-13.3), -18 (95% CI -27.6;-8.5), -16.9 (95% CI -27.3;-6.5), mmHg, at 6, 12, and 36 month, respectively. In group of conventional main trunk treatment the same BP decreased substantially less at all study periods, and lost significance at 36 month. -10.3 (95% CI -17.8;-2.8), -12.1 (95% CI -19.2;-5.0), -8.7 (95% CI -19.7;2.2). Other ambulatory BP indices changed accordingly. eGFR decreased in group of distal RDN at 1 year post-procedure -8.9 (95% CI -14.8;-3.1), mL/min/sq.m, however, slightly increased during next 2 years with finally non-significant change at the end of the study, -6.5 7 (95% CI -13.2;0.3). In contrast, in group of main trunk treatment eGFR remained unchanged during 1st year, -1.3 (95% CI -6.6;4.0) but progressed to statistically significant decrease at 3-year post-procedure, -5.0 (95% CI -9.6;-0.3). Conclusions: Anatomical optimization of renal denervation by redistributing treatments to segmental branches of renal artery produces a durable increase in the efficacy of the intervention without additional risk to the kidney.

EFFECTS OF DISTAL RENAL DENERVATION VERSUS CONVENTIONAL INTERVENTION ON THE HEART IN PATIENTS WITH RESISTANT HYPERTENSION

Objective: The aim of this study was to evaluate of state the heart after distal renal denervation (DRD) in segmental branches of renal artery versus conventional main trunk therapy: 12 month study in patients with resistant hypertension (RH). Design and method: All participants of research have given the informed agreement. This was a double-blind, randomized prospective study (NCT01499810) in 55 patients meeting criteria of true RH. Patients were randomized either to endovascular “conventional” renal denervation (CRD) of the main renal arteria (n = 27) or to distal (D) treatment applied in segmental branches after the bifurcation of the main renal arteria (n = 28). Echocardiography was making from standards method. It was protocol ASE-convention. Parameters of office BP, IVS - interventricular septum, PSV - posterior wall of the left ventricle, LA - left atrium, LVM - left ventricular mass, and myocardial stress (MS) were performed at baseline and 12 months follow-up. Statistical analysis: descriptive, t-test independent by groups, t-test dependent samples. Results: Forty six patients completed 12 month follow-up: after CRD (n = 24) and after DRD (n = 22). A significantly greater decreased parameters of 24-hour BP (-11.5 ± 16.3 vs -22.0 ± 20.3 mm Hg, p < 0.05) and the left ventricle of heart: IVS - interventricular septum (-0.21 ± 1.3 vs -1.2 ± 1.8 p < 0.05 mm), PSV - posterior wall of the left ventricle (0.20 ± 1.2 vs -0.86 ± 1.7 p < 0.05 mm), LA - left atrium (0.96 ± 2.8 vs -1.36 ± 9.6 p > 0.05 mm), LVM - left ventricular mass (-4.9 ± 37.4 vs -36.3 ± 34.5 p < 0.05 g), and MS (-1784.0 ± 2294 vs -5133.6 ± 1556.2 p < 0.05 dynes / cm2) were performed at baseline and 12 months follow-up. Conclusions: Distal RD treatment applied in segmental branches after the bifurcation of the main renal arteria compared with “conventional” renal denervation in in the main trunk of the renal artery further reduces myocardial stress, as well as a positive impact on the parameters of the left ventricle, but not the left atrium 12 months after renal denervation in patients with resistant hypertension.

Anatomical Study of Renovascular Variations: A Cadaveric Study from Central India

Introduction: The knowledge of the accessory renal arteries has grown importance with the increasing number of renal transplants and other uroradiological procedures and for surgeons in view of nephrectomy and segmental renal resections. Renal artery variations include their origin, number and course. The most common is the presence of additional vessels. There may be several renal arteries or veins on each side or the renal artery may divide close to its origin into several branches. Aim and Objective: To study morphological variations and anomalies in the renal vasculature of Kidney. Material and Method: In order to facilitate the clinical approaches, we studied renal vascular pattern in 50 embalmed cadavers during the period of two years to establish the incidence of additional renal vessels in human cadavers and to understand the abnormalities of anatomical and embryological variations. Results: In our study we found, renal artery passing anterior to renal vein. Study also showed that accessory renal arteries arising from aorta are passing few to the upper pole, few to the lower pole unilaterally and few showed the same variation bilaterally. Early segmental branches of renal artery before entering the kidneys were also found in our study. Renal vein passing behind the abdominal aorta in one case and two or more renal veins at the hilum of kidney were also found in our study. Conclusion: Total renovascular variations were found in 42.42% cadavers. Detailed review of the literature shows that variations of renal arteries are more common than the renal veins, but in present study we found variations of renal veins (27.27%) more than the renal arteries(12.12%). A detailed knowledge of variations of renal vessels is obligatory for the safe performance of endovascular, laparoscopic, uroradiological procedures, renal transplants, clamping of vessels during partial nephrectomy and abate the complications in various procedures.

TCT-203 A distal mode of renal denervation in segmental branches of renal artery versus conventional main trunk therapy: a double blind randomized controlled study in patients with resistant hypertension

TCT-203 A distal mode of renal denervation in segmental branches of renal artery versus conventional main trunk therapy: a double blind randomized controlled study in patients with resistant hypertension

4120Distal renal denervation in segmental branches of renal artery versus conventional main trunk therapy: 12 months study in patients with resistant hypertension

4120Distal renal denervation in segmental branches of renal artery versus conventional main trunk therapy: 12 months study in patients with resistant hypertension

8B.05

Objective: Actual procedure of renal denervation (RD) in Symplicity HTN-3 study - 4–6 point ablations equally distributed along the length and circumference of main trunk of renal artery (RA) - may only be effective if renal nerves are likewise equally distributed along and around the RA strictly following its course. However, a number of surgical studies demonstrated that renal nerves form a fan-shaped triangle plexus converging toward hilum, i.e. proximally the nerves go at a distance from RA obliquely to its course and join it in the middle/distal portion so that number of fibers available for endovascular ablation is small in proximal portion of RA but rises to maximum in its distal part. To evaluate whether ablation of sympathetic nerves in distal part of RA is more effective than conventional RD treatment equally distributed in its main trunk. Design and method: We initiated randomized (1:1) controlled study in which we compare the modified operative technique (ablations performed in distal part and major branches of RA) with conventional RD in patients with resistant hypertension using Symplicity device. Results: At the time of this analysis 26 patients (13 treated by modified technique and 13 – by conventional RD) completed 6 months follow up. The only complication was 1 post-punctional pseudoaneurysm. Ambulatory BP decreased significantly in the group of modified technique: -21.3/-11.5 (SD 20.5/11.2) mmHg (mean 24-hr BP, systolic/diastolic respectively), p = 0.003/0.003 and only slightly in the group of standard RD: -6.2/-4.5 (SD 16.4/8.3) p = 0.19/0.07. The difference in the effects was statistically significant for mean 24-h systolic BP (p = 0.049) and close to significance for mean 24-h diastolic BP (p = 0.085). Office BP lowering did not differ significantly between groups: -25.3/-10.8 vs -22.1/-12.1 respectively. Conclusions: Radiofrequency denervation of distal part and segmental branches of renal artery based on the surgical findings of distal convergence of renal nerves seems to be significantly more effective than existed mode of RD presuming equal nerve availability along the artery. This may indicate anatomical inadequacy of the existed mode of RD explaining its failure in Symplicity HTN-3 trial.

English

Address for Correspondence: Shaik Hussain Saheb, Assistant Professor of Anatomy, JJM Medical College, Davangere, Karnataka, India. Mobile +91-9242056660. E-Mail: anatomyshs@gmail.com Access this Article online Quick Response code Web site: 1 Assistant Professor of Anatomy, Travancore Medical College, Kollam, Kerala, India. 2 Professor of Anatomy, JSS Medical College, Mysore, Karnataka, India. 3 Assistant Professor of Physiology, Travancore Medical College, Kollam, Kerala, India. *4 Assistant Professor of Anatomy, JJM Medical College, Davangere, Karnataka, India. Background: Based on vascular divisions the renal tissue divided into five segments that are apical, anterior superior, anterior inferior, inferior and posterior. The apical segment occupies the antero medial region of the superior pole. The superior segment includes the rest of the superior pole and the central antero-superior region. The segmental arteries of the kidney supply the organ in such a way that, each renal pole receives its own artery while, the anterior portion between the poles is supplied by an upper and lower segmental vessel. The present study concentrated on variation of superior segmental artery which is help in nephrology clinical practice. Materials and Methods: Fifty pairs of kidneys with intact abdominal aorta and renal artery were collected from the dead bodies obtained from the mortuary of Forensic department, JSS Medical College and Mysore Medical College and studied in JSS Medical College. For study of segmental variation Corrosion cast technique method was used. Results: In present study type I superior segmental artery were found in 28%, type II in 12%, type III in 14%, type IV 20%, type V in 1% o and type VI 23% of cases. Conclusions: We observed variations in superior segmental branch of renal artery in 100 kidneys and observed 6 types of variation. These knowledge of vascular segments of kidney helpful for the clinician to do renal transplantation interventional radiological procedures.