The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study.

PURPOSE: Horseshoe kidney is a rare congenital anomaly with potential clinical implications. The aim of this study was to determine the number of renal arteries and veins and the level at which the arteries branched off their parental vessels in individuals with horseshoe kidney (HSK) and in persons with separated kidneys (SK). MATERIALS AND METHODS: The analysis included computed tomography angiography studies of 331 patients (83 HSK and 248 SK). The number of renal vessels and diameters of renal arteries were determined, along with the level at which they branched in relation to other ramifications (four groups of origin were proposed) and their entrance of the vessels to the kidney. RESULTS: Number of renal arteries in HSK group was 4.57 ± 1.39 per patient and 2.4 ± 0.43 in SK group (p < 0.0001). The distribution of branching level of renal arteries in HSK group was: I group ~ 57%, II group ~ 27%, III group ~ 15% and IV group < 1%, whereas in SK group the distribution was respectively: I group ~ 99%, II group < 1%, III and IV group - 0% (p = 0.0001). In HSK group, diameter of renal arteries branching above the IMA was 4.61 ± 1.58 mm, as compared with 3.96 ± 1.34 mm for the arteries branching below (p = 0.0004). Number of veins was 566 in SK group (87.70% of kidneys were supplied by single vein) and 323 in HSK group (9.64% kidneys were supplied by two veins) (p < 0.0001). CONCLUSION: In HSK group, renal arteries significantly more often branch off their parental vessels below the origin of IMA and such vessels are usually smaller.

Right aortic arch analysis - Anatomical variant or serious vascular defect?

BACKGROUND: The right-sided aortic arch (RAA) is a rare congenital defect of the aorta. The aim of the study was to assess the occurrence of RAA in diagnoses performed by the University Radiology Department and analyze the frequency of concomitant vascular abnormalities. METHODS: The database of the Radiology Department was retrospectively analyzed between January 2008 and May 2016 with the keyword "right aortic arch". Twenty patients with this diagnosis were identified from a total of 11,690 CT examinations of the chest area, 19,623 CT examinations of brain-supplying vessels, and 1863 MRI examinations of the heart and aortic arch or brain-supplying arteries. The type of aortic arch, the occurrence of Kommerell's diverticulum and possible other vascular abnormalities, such as stenosis, kinking or occlusion, were then investigated. RESULTS: The analysis identified nine patients with type I and 11 patients with type II RAA. Eight of the 11 type II patients presented Kommerell's diverticulum. Concomitant vascular abnormalities were detected in four patients with type II RAA. In two cases, the right common carotid artery (RCCA) was narrowed by up to 80%, with steal phenomenon confirmed in one of them. In the second coincident right subclavian artery (RSA) stenosis was depicted. In two other cases, the aberrant left subclavian arteries (ALSA) were found to be narrowed at the level of origin by up to 70%. One patient was found with type B aortic dissection including ALSA and Kommerell's diverticulum. CONCLUSIONS: Our observations indicate that concomitant vascular abnormalities may occur more often than reported in literature. Patients diagnosed with type II RAA should be examined with Doppler ultrasonography to identify coincident vascular disorders, especially stenosis of the common carotid arteries or subclavian arteries.

Median arcuate ligament syndrome: Predictor of ischemic complications?

Median arcuate ligament syndrome (MALS) is a pathologic entity that can affect the celiac axis. Due to the extensive collateral network of mesenteric circulation, stenosis of one mesenteric artery does not lead to significant symptoms. The purpose of this study was to describe multidetector computed tomography (MDCT) angiography findings of celiac artery entrapment by the median arcuate ligament and determine those patients with high risks of ischemic complications. From January 2012 to March 2016, 103 patients with celiac artery (CA) compression by median arcuate ligament were detected. In 23 patients collateral circulation was developed. In order to investigate the problem, we managed to estimate the correlation between range of stenosis of CA and presence of collateral circulation between the celiac artery (CA) and superior mesenteric artery (SMA). A statistically significant correlation was found between range of CA stenosis and collateral circulation presence (Spearman's correlation coefficient 0.339, P < 0.0001). In conclusions, based on our observations, we hypothesize that ischemia as a result of mesenteric vessel narrowing by the median arcuate ligament may occur more often than indicated by clinical symptoms and described in literature. Clin. Anat. 29:1025-1030, 2016. © 2016 Wiley Periodicals, Inc.

An unusual case of left renal artery compression: a rare type of median arcuate ligament syndrome.

Compression from median arcuate ligament was observed during multidetector 64-row computed tomography in a Caucasian 30-year-old female. The patient was referred for examination to exclude anatomical pathologies causing hypertension. The examination demonstrated that left renal artery, which had its origin in the chest (at the level of upper one-third of Th12), was compressed as it passed by median arcuate ligament of the diaphragm. In addition, aortic compression and kinked shape was also revealed.

Characteristics, management and five-year outcomes of patients with high risk, stable multivessel coronary heart disease.

BACKGROUND: Multivessel coronary artery disease (MCAD) is a common manifestation of advanced coronary atherosclerosis. AIM: To determine the clinical characteristics and long term follow up prognostic factors in patients with high risk, stable MCAD from a single institution. METHODS: We included in the final analysis 270 patients with stable MCAD. Patients were followed for the occurrence of death, stroke and myocardial infarction (MI). We defined a cumulative major adverse cardiac and cerebrovascular event (MACCE) asa composite of death, stroke, MI and urgent revascularisation. Median follow up was 5 years (4-5.5 years). 176 (65%) patients were treated surgically (coronary artery bypass grafting, CABG), 19 (7%) patients were treated percutaneously, while 75 (28%) patients were treated medically; this meant that 94 (35%) patients were treated non-surgically. RESULTS: Predictors of MACCE in the study group of patients revealed by univariate logistic regression analysis were: diabetes mellitus (p = 0.04), kidney failure (p = 0.05), total cholesterol (p = 0.05), LDL-cholesterol (p = 0.02), chest pain symptoms in CCS III class (p = 0.05), heart rate (p = 0,02), NT-proBNP (p = 0.01), left ventricular diastolic (p = 0.003) and systolic diameter (p = 0.003), left ventricular ejection fraction (p = 0.001), Gensini score (p = 0.05) and CABG treatment strategy (p = 0.001). In Cox logistic regression analysis, non CABG treatment strategy (b = 0.06), heart rate (b = 0.02), and LDL cholesterol level (b = 0.006) were independent predictors of MACCE (p = 0.01). CONCLUSIONS: Our study showed that patients with advanced MCAD who are qualified for complete surgical revascularisation benefitted more with regard to several primary end points at five-year follow-up than those who were not qualified for surgery and who were treated with medical therapy supplemented in selected cases with incomplete percutaneous revascularisation.

[A 59 year-old patient with acute anterolateral myocardial infarction, complicated by cardiogenic shock, with chest wall deformity caused by Heine-Medin disease]. / Mezczyzna w wieku 59 lat z zawalem sercasciany przednio−bocznej, we wstrzasie kardiogennym, z deformacja klatki piersiowej w przebiegu poliomyelitis.

We report a case of a 59 year-old patient in a condition of acute myocardial infarction with ST elevation, in a cardiogenic shock, with multiple cardiac arrests in mechanism of ventricular fibrillation with a significant chest wall deformity caused by Heine-Medin disease in childhood. To our knowledge, this is the first case report of a patient in critical condition with a considerable pectus deformity after poliomyelitis who needed to undergo cardiovascular angioplasty. Although severe patient's condition and numerous difficulties during percutaneous coronary intervention, therapy was successful.

[Coronary steal syndrome in a patient with ST-elevation myocardial infarction one year after coronary bypass grafting]. / Zespól podkradania wiencowo-piersiowego u pacjenta z zawalem serca z uniesieniem odcinka ST rok po operacji pomostowania aortalno-wiencowego.

Some patients after coronary artery bypass grafting (CABG) in long term follow-up need consecutive reinterventions due to progression of atherosclerotic changes or degeneration of venous bypass grafts. A rare cause of the recurrence of angina after CABG operation is coronary artery steal syndrome. We demonstrate a case report of a 66 year-old man after CABG procedure with a condition of acute myocardial infarction induced by steal syndrome of the side branch of left internal mammary artery.