Selective Renal Artery Angiography Research Articles

Factors affecting hemostasis in the control of iatrogenic renal hemorrhage.

To investigate factors affecting hemostasis in iatrogenic renal hemorrhage. Seventy-three patients with iatrogenic renal hemorrhage experiencing selective renal artery angiography between Jan 2015 and Dec 2020 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. Factors affecting hemostasis were analyzed by univariate and multivariate models using linear regression techniques. The optimum values of the independent factors to predict postangiographic hemostasis were conducted by receiver operating characteristic (ROC) curve analysis. Of the 73 iatrogenic renal hemorrhage patients, 47 (64.4%) patients had positive angiographic findings and received therapeutic embolization. Of the patients with negative angiographic findings, 20 (76.9%) and 6 (23.1%) received conservative therapy and prophylactic embolization, respectively. The red blood cell (RBC) count (OR = 0.61, P = 0.04), the hematuria time before angiography (OR = -0.19, P < 0.01) and treatment modality were independent factors affecting hemostasis time. The ROC curve analysis showed that the RBC count of 3.5 × 109/L and the hematuria time before angiography of 7days were the optimum indicators. Therapeutic embolization and prophylactic embolization were protective factors affecting hemostasis time compared with conservative treatment (OR = -1.59, P = 0.02; OR = -3.31, P < 0.01). The hematuria time before selective renal artery angiography, the RBC count, and embolization treatment are associated with rapid hemostasis. Embolization is an effective strategy for iatrogenic renal hemorrhage, and also enables rapid hemostasis in patients with negative angiographic findings.

Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension.

With increasing attention to renovascular causes and targets for hypertension there arises a critical need for more detailed knowledge of renal arterial anatomy. However, a standardised nomenclature is lacking. The present study sought to develop a standardised nomenclature for renal anatomy considering the complexity and variation of the renal arterial tree and to assess the applicability of the nomenclature. One thousand hypertensive patients underwent invasive selective renal artery angiography in nine centres. Further, renovasography was performed in 249 healthy swine as a surrogate for normotensive anatomy. Anatomical parameters were assessed by quantitative vascular analysis. Patients' mean blood pressure was 168/90±26/17 mmHg. The right main renal artery was longer than the left (41±15 mm vs. 35±13 mm, p<0.001), but the left had a greater diameter (5.4±1.2 vs. 5.2±1.2 mm, p<0.001). Accessory renal arteries and renal artery disease were documented in 22% and 9% of the patients, respectively. Other than exhibiting a longer left main renal artery in uncontrolled hypertensives (+2.7 mm, p=0.034) there was no anatomical difference between patients with controlled and uncontrolled hypertension. Main renal artery mean diameter was smaller in patients with impaired kidney function (GFR <90 ml/min, left -0.5 mm, right -0.4 mm, both p<0.001). Renal arterial anatomy differs between sides but shows no difference between patients with and without blood pressure control. Impaired GFR was associated with small main renal artery diameter.

Anatomical Eligibility of the Renal Vasculature for Catheter-Based Renal Denervation in Hypertensive Patients

This study sought to determine the vascular anatomical eligibility for catheter-based renal artery denervation (RDN) in hypertensive patients. Arterial hypertension is the leading cardiovascular risk factor for stroke and mortality globally. Despite substantial advances in drug-based treatment, many patients do not achieve target blood pressure levels. To improve the number of controlled patients, novel procedure- and device-based strategies have been developed. RDN is among the most promising novel techniques. However, there are few data on the vascular anatomical eligibility. We retrospectively analyzed 941 consecutive hypertensive patients undergoing coronary angiography and selective renal artery angiography between January 1, 2010, and May 31, 2012. Additional renal arteries were divided into 2 groups: hilar (accessory) and polar (aberrant) arteries. Anatomical eligibility for RDN was defined according to the current guidelines: absence of renal artery stenosis, renal artery diameter ≥4 mm, renal artery length ≥20 mm, and only 1 principal renal artery. A total of 934 hypertensive patients were evaluable. The prevalence of renal artery stenosis was 10% (n = 90). Of the remaining 844 patients without renal artery stenosis, 727 (86%) had nonresistant hypertension and 117 (14%) had resistant hypertension; 62 (53%) of the resistant hypertensive and 381 (52%) of the nonresistant hypertensive patients were anatomically eligible for sympathetic RDN. The vascular anatomical eligibility criteria of the current guidelines are a major limiting factor for the utilization of RDN as a therapeutic option. Development of new devices and/or techniques may significantly increase the number of candidates for these promising therapeutic options.

Percutaneous transcatheter super-selective embolization of a tributary of an accessory renal artery to control traumatic haematuria from a horseshoe kidney-a case report

Objectives: The most experienced clinicians could easily miss serious renal injury at surgery. We report a case of a recently diagnosed bleeding from a lacerated horseshoe kidney with a review of the literature. Methods: The clinical and imaging records and laboratory results of a patient with blunt abdominal trauma were reviewed who initially underwent splenectomy for splenic injury, but a renal injury was missed at laparotomy. We also carried out a review of published reports of renal artery injuries. Results: A thirty-year-old man was admitted as an emergency to a hospital after he had sustained blunt abdominal trauma in a go-carting accident. He underwent splenectomy for splenic injury following which he was discharged. A few days later, he was seen in another hospital complaining of left loin pain where, a provisional diagnosis of urinary tract infection and possible haematoma around his splenic bed was made. He discharged himself against medical advice before further imaging could be undertaken. He presented to a third hospital with abdominal pain and then developed haematuria severe enough for him to be transfused. Ultra-sound scan and CT-scan of the abdomen and pelvis showed injury to a horseshoe kidney with haematoma which was initially drained percutaneously. Post contrast axial CT scans showing the transacted kidney and active renal bleeding are shown in Figures 1 & 2. A selective renal artery angiogram confirmed bleeding from a tributary of an accessory descending left renal artery that was successfully treated by super-selective embolization (Figures 3, 4, 5 and post embolization CT Figure 6). Conclusions: Ultrasonography and Computed Tomography are instrumental in the diagnosis of a horseshoe kidney. Both ultrasound and CT scans confirm a renal/peri-renal haematoma resulting from renal trauma. Selective renal artery angiography not only confirms the source of bleeding but also allows superselective arterial embolization as a definite or stopgap treatment.Super-selective embolization of renal haemorrhage is comparatively non-invasive and preferred to open surgery.

Elective and emergency selective renal artery angio-graphy and embolization of angiomyolipoma: a report of two cases and review of the literature

Objectives : With developments in interventional radiology, selective renal artery angiography and super-selective embolization is gradually being used as an alternative treatment modality for angiomyolipoma of the kidney instead of nephrectomy or partial nephrectomy. It has been suggested that the use of steroids around the time of embolization may reduce or avoid post-embolization syndrome. Our aim is to report two cases of angiomyolipoma of kidney that were treated electively and as an emergency procedure with a review of the literature. Methods : Detailed clinical records of the two patients were obtained from their case notes, ALS records of clinic letters and discharge summaries, PACS system for records of all radiological procedures, computerized results of all laboratory tests in order to document the presentation, investigation, management and outcome of management of the patients. Literature was reviewed on embolization of angiomyolipoma of the kidney. Results : Two patients with angiomyolipoma of the kidney, (the first patient a lady with an enlarging angiomyolipoma of the right kidney and the second patient a lady who had spontaneous haemorrhage into a large angiomyolipoma of her right kidney), underwent selective right renal artery angiography and supers-selective embolization of the feeding vessels of their angiomyolipomas. The first patient was given steroid cover (Hydrocortisone and prednisolone) for two weeks in order to reduce or minimise the development of post-embolization syndrome. The second patient was not given any steroid cover. The first patient was discharged home on the first day after her embolization procedure and she did not develop any complications. The second patient who was not given any steroid cover developed post-embolization syndrome which eventually resolved after about six weeks. Literature review indicates that post-embolization syndrome is common after embolization. There is some evidence in the literature to suggest that the use of a short course of steroids around the time of embolization procedure reduces or prevents the development of post-embolization syndrome. Conclusions: Selective renal artery angiography can be used to diagnose a non-bleeding-angiomyolipoma, as well as bleeding enlarged angiomyolipoma of kidney. Super-selective renal artery embolization of a large angiomyolipoma of the kidney is a useful alternative to partial nephrectomy or full nephrectomy; it has the advantage of not requiring general anaesthesia and it is associated with less morbidity than nephrectomy or partial nephrectomy. Our limited experience and literature review would suggest that perhaps the use of steroids around the time of embolization may reduce the incidence of post-embolization syndrome.

Fibromuscular dysplasia of renal arteries: Percutaneous revascularization based on hemodynamic assessment with a pressure measurement guidewire

Fibromuscular dysplasia (FMD) leading to renal artery stenosis and hypertension is one of the most common treatable causes of secondary hypertension. However, frequently it can be difficult to judge the anatomical severity of a stenotic lesion with various noninvasive and invasive imaging modalities. We present two patients with poorly controlled hypertension and FMD affecting the renal arteries, in whom there were no anatomically significant stenoses by renal magnetic resonance angiography or selective renal artery angiography. Utilizing a 0.014'' high fidelity micromanometer tipped PressureWire XT (Radi, Reading, MA), to measure intravascular pressure gradients throughout the diseased renal arteries, we identified physiologically significant stenoses, and successfully treated both patients with percutaneous transluminal angioplasty.

Su di un caso di carcinoma a cellule chiare in nefroma cistico multiloculare

A case of adenocarcinoma of the kidney in a multilocular cystic disease is reported. The many diagnostic pitfalls of this rare association are underlined and the diagnostic role of selective renal artery angiography, which removed all doubt about the lesion.