RESUMO
A 41-year-old male patient presented to the hospital with chest tightness and intermittent chest pain. Cardiac ultrasonography revealed a metallic foreign body in the right ventricle, accompanied by tricuspid insufficiency. A chest computed tomographic scan further confirmed a foreign body stuck at the opening of the tricuspid valve. The 14- × 40-mm stent was removed from the right ventricle through a thoracotomy. The patient had undergone left renal venous stenting 1 month earlier for treatment of nutcracker syndrome. Thus, for patients who have received left renal venous stenting for treatment of nutcracker syndrome, clinicians should pay due attention to stent graft migration.
Assuntos
Remoção de Dispositivo/métodos , Procedimentos Endovasculares/métodos , Migração de Corpo Estranho/etiologia , Veias Renais/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Angiografia por Tomografia Computadorizada , Ecocardiografia , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Veias Renais/lesões , Stents/efeitos adversos , Insuficiência da Valva Tricúspide/diagnósticoRESUMO
Abdominal trauma leads rarely to severe renal injury such as acquired arterioveinous fistula. Here, we present the case of a 46-year-old man with a history of suicide attempt by a gunshot in the abdomen. At that time, explorative laparotomy was unremarkable. He consulted 23 years later for chronic left lumbar pain and was diagnosed with an arterioveinous fistula of left renal vessels with a-10-cm aneurysm of the left renal artery. We performed a left nephrectomy and endovascular clamping was the best option to manage this giant aneurysm in a hostile abdomen.
Assuntos
Traumatismos Abdominais/etiologia , Aneurisma/etiologia , Fístula Arteriovenosa/etiologia , Artéria Renal/lesões , Veias Renais/lesões , Lesões do Sistema Vascular/etiologia , Ferimentos por Arma de Fogo/complicações , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Doenças Assintomáticas , Constrição , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Veias Renais/diagnóstico por imagem , Veias Renais/cirurgia , Tentativa de Suicídio , Fatores de Tempo , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgiaRESUMO
BACKGROUND: Intravenous misplacement of a nephrostomy tube is a rare complication of percutaneous nephrolithotomy (PCNL) or percutaneous nephrostomy. The mechanism of misplacement of a nephrostomy tube into the vascular system is seldom investigated. One type of the possible mechanism is that the puncture needle penetrates a major intrarenal tributary of the renal vein and enters the collecting system. However, the guidewire is located outside the collecting system near the large branches of renal vein or perforates into the renal vein. The dilation is performed and causes a large torn injury. Subsequently, the nephrostomy tube is placed inside the vessel when radiological monitoring is not used. However, there is no imaging evidence and the scene of procedure is not demonstrated. This paper reports two cases of visualization of the renal vein filled with contrast agent during PCNL. The findings may be good evidence to support the step of renal vein injury in patients with intravenous nephrostomy tube misplacement. CASE PRESENTATION: We presented two cases with visualization of the renal vein filled with contrast agent during PCNL. In the process of injecting the contrast agent through the puncture needle, we could see the renal vein. Moreover, it was identified that the puncture needle tip was not on the optimal position. The position of puncture needle tip lay outside the collecting system, which was close to the calyceal infundibulum and branches of renal vein. CONCLUSIONS: Visualization of the renal vein filled with contrast agent may be good evidence to verify the renal vein injury in patients with intravenous nephrostomy tube misplacement during PCNL or percutaneous nephrostomy. The suboptimal location of the puncture needle tip and visualization of the renal vein filled with contrast agent indicate the renal vein injury. One type of mechanism of intravenous nephrostomy tube misplacement is as following. Firstly, the guidewire stays outside the collecting system. Subsequently, dilatation directed by the guidewire results in the injury of the vein. Then, the nephrostomy tube migrates into the venous system due to prompt tube inserting and the direction of the sheath and/or the guidewire to the injured vein.
Assuntos
Meios de Contraste/análise , Erros Médicos , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Veias Renais/lesões , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Veias Renais/diagnóstico por imagemRESUMO
BACKGROUND: Major pancreatic injuries are complex to treat, especially when combined with vascular and other critical organ injuries. This case-matched analysis assessed the influence of associated visceral vascular injuries on outcome in pancreatic injuries. METHOD: A registered prospective database of 461 consecutive patients with pancreatic injuries was used to identify 68 patients with a Pancreatic Injury combined with a major visceral Vascular Injury (PIVI group) and were matched one-to-one by an independent blinded reviewer using a validated individual matching method to 68 similar Pancreatic Injury patients without a vascular injury (PI group). The two groups were compared using univariate and multivariate logistic regression analysis and outcome including complication rates, length of hospital stay and 90-day mortality rate was measured. RESULTS: The two groups were well matched according to surgical intervention. Mortality in the PIVI group was 41% (n = 28) compared to 13% (n = 9) in the PI alone group (p = 0.000, OR 4.5, CI 1.00-10.5). On univariate analysis the PIVI group was significantly more likely to (i) be shocked on admission, (ii) have a RTS < 7.8, (iii) require damage control laparotomy, (iv) require a blood transfusion, both in frequency and volume, (v) develop a major postoperative complication and (vi) die. On multivariate analysis, the need for damage control laparotomy was a significant variable (p = 0.015, OR 7.95, CI 1.50-42.0) for mortality. Mortality of AAST grade 1 and 2 pancreatic injuries combined with a vascular injury was 18.5% (5/27) compared to an increased mortality of 56.1% (23/41) of AAST grade 3, 4 and 5 pancreatic injuries with vascular injuries (p = 0.0026). CONCLUSION: This study confirms that pancreatic injuries associated with major visceral vascular injuries have a significantly higher complication and mortality rate than pancreatic injuries without vascular injuries and that the addition of a vascular injury with an increasing AAST grade of pancreatic injury exponentially compounds the mortality rate.
Assuntos
Pâncreas/lesões , Pâncreas/cirurgia , Sistema Porta/lesões , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/mortalidade , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Aorta/lesões , Transfusão de Sangue , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Masculino , Artéria Mesentérica Superior/lesões , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Artéria Renal/lesões , Veias Renais/lesões , Choque/etiologia , Artéria Esplênica/lesões , Taxa de Sobrevida , Índices de Gravidade do Trauma , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/lesões , Adulto JovemRESUMO
INTRODUCTION: Although many radiologists invoke the surgical classification of renal injury proposed by the American Association for Surgery in Trauma (AAST), there has been only limited work on the role of the AAST system as an imaging stratification. The aim was to determine the inter-rater reliability (IRR) amongst radiologists and urologists using the AAST system. METHODS: A 1-year retrospective study of consecutive patients with computed tomography (CT) evidence of renal trauma managed at a Level 1 trauma center. Three radiologists and three urologists independently stratified the presentation CT findings according to the AAST renal trauma classification. Agreement between independent raters and mutually exclusive groups was determined utilizing weighted kappa coefficients. RESULTS: One hundred and one patients were included. Individual inter-observer agreements ranged from 54/101 (53.4%) to 62/101 (61.4%), with corresponding weighted kappa values from 0.61 to 0.69, constituting substantial agreement. Urologists achieved intra-disciplinary agreement in 49 cases (48.5%) and radiologists in 36 cases (35.6%). Six-reader agreement was achieved in 24 cases (23.7%). The AAST grade I injuries had the highest level of agreement, overall. CONCLUSION: The finding of substantial IRR amongst radiologists and urologists utilizing the AAST system supports continued use of the broad parameters of the AAST system, with some modification in specific categories with lower agreement.
Assuntos
Contusões/classificação , Hematoma/classificação , Rim/lesões , Lacerações/classificação , Variações Dependentes do Observador , Lesões do Sistema Vascular/classificação , Contusões/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Lacerações/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Radiologistas , Artéria Renal/diagnóstico por imagem , Artéria Renal/lesões , Veias Renais/diagnóstico por imagem , Veias Renais/lesões , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Urologistas , Lesões do Sistema Vascular/diagnóstico por imagemRESUMO
BACKGROUND: Major venous injury during open aortic reconstruction though uncommon often result in sudden and massive blood loss resulting in increased morbidity and mortality. This study details the etiology, management, and outcome of such injuries. METHODS: A retrospective review of 945 patients (1981-2017) undergoing aortic reconstruction from 2 midsized (350 bed each) teaching hospitals was conducted. Seven hundred twenty-three patients (76.5%) underwent open abdominal aortic aneurysm (AAA) repair/iliac aneurysm repair, 222 patients (23.5%) underwent aortofemoral grafting (AFG). Patients sustaining major venous injury (sudden loss of more than 500 mL of blood) during major aortic reconstruction were studied. The number of units of packed red blood cells transfused, location of injured vessel, type of repair, postoperative morbidity, and mortality were collected in our vascular registry on a continuous basis. All patients identified with iliac vein/inferior vena cava/femoral vein injury had follow-up noninvasive venous examination of the lower extremities. RESULTS: Eighteen major venous injuries (1.9%) occurred during aortic reconstruction in 17 patients (1 patient had 2 major venous injuries): IVC (n = 4), iliac vein (n = 10), left renal vein (n = 4, this includes a posterior retroaortic renal vein injury n = 1). Of the 18 major venous injuries, 7 occurred during open AAA repair for ruptured AAA and another 9 occurred during repair of intact AAA (P = 0.001), 2 venous injuries occurred after AFG, and 1 after primary AFG (P = 0.05). Using multivariate regression analysis, periarterial inflammation had significant association with major venous injury (P < 0.001). The presence of associated iliac aneurysm with abdominal aortic aneurysm also increased the incidence of major venous injury during AAA surgery (P = 0.05). Two patients (11.8%) died, one from uncontrolled bleeding due to tear of right common iliac vein during ruptured AAA repair and second patient from disseminated intravascular complication following repair of ruptured AAA. Intraoperative transfusion requirements were 3-28 units, (median 8 units). Three of 9 (33%) surviving patients developed iliofemoral venous thrombosis following repair of iliac/femoral vein injury. CONCLUSIONS: Major venous injury during aortic reconstructions occurs more commonly during the repair of ruptured AAA and redo AFG. Following repair of iliac/femoral vein injury, surveillance for possible deep venous thrombosis by duplex imaging should be considered.
Assuntos
Aorta/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Doença Iatrogênica , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/etiologia , Veias/lesões , Idoso , Aorta/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Distribuição de Qui-Quadrado , Feminino , Número de Leitos em Hospital , Hospitais de Ensino , Humanos , Veia Ilíaca/lesões , Modelos Logísticos , Masculino , Michigan , Análise Multivariada , Razão de Chances , Procedimentos de Cirurgia Plástica/mortalidade , Sistema de Registros , Veias Renais/lesões , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Ultrassonografia Doppler Dupla , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/terapia , Veias/diagnóstico por imagem , Veia Cava Inferior/lesões , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologiaRESUMO
A 26-year-old man presented with gunshot wound to the epigastrium. At surgery, he was hemodynamically stable and had a tense hematoma with thrill in zone 2 (right side) and porta triad. After liver injury was controlled, he underwent percutaneous stenting of a renal artery-vena cava fistula and the hepatic artery injury was followed. Historically, penetrating injury to zone 2 has mandated operative exploration. However, with the advent of endovascular options, in stable patients, catheter-based options offer a reasonable alternative with less risk of blood loss and possible nephrectomy. Renal artery stenting has been advocated for renal artery cava fistulas. The role of timing, hybrid operating suites, and traditional operative exposure will vary based on presentation and institutional capabilities.
Assuntos
Traumatismos Abdominais/cirurgia , Procedimentos Endovasculares/métodos , Hematoma/cirurgia , Fígado/cirurgia , Artéria Renal/cirurgia , Fístula Vascular/cirurgia , Veia Cava Inferior/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Adulto , Contusões , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Humanos , Fígado/diagnóstico por imagem , Fígado/lesões , Vértebras Lombares/lesões , Masculino , Pâncreas/lesões , Veia Porta/diagnóstico por imagem , Veia Porta/lesões , Artéria Renal/diagnóstico por imagem , Artéria Renal/lesões , Veias Renais/diagnóstico por imagem , Veias Renais/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Stents , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico por imagemAssuntos
Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Doença da Artéria Coronariana/cirurgia , Veias Renais/anormalidades , Idoso , Aneurisma da Aorta Abdominal/complicações , Humanos , Masculino , Veias Renais/lesões , Veias Renais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Embolização Terapêutica/métodos , Artéria Renal/anormalidades , Veias Renais/anormalidades , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Angiografia Digital/métodos , Fístula Arteriovenosa/classificação , Fístula Arteriovenosa/terapia , Biópsia/efeitos adversos , Cateterismo , Embolização Terapêutica/instrumentação , Embucrilato , Procedimentos Endovasculares/métodos , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Rim/irrigação sanguínea , Rim/patologia , Angiografia por Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Artéria Renal/diagnóstico por imagem , Artéria Renal/lesões , Veias Renais/diagnóstico por imagem , Veias Renais/lesões , Ultrassonografia Doppler em Cores/métodosRESUMO
Renal arteriovenous fistulas (AVFs) are an uncommon complication of nephrectomy. In this report, we present the case of a 66-year-old female presenting with progressive dyspnea on exertion and exercise intolerance. She was diagnosed and treated for adult onset reactive airway disease. The patient underwent nephrectomy at age 18 secondary to recurrent pyelonephritis from vesicoureteral reflux. She underwent a surveillance computed tomography (CT) scan to evaluate a small ascending aneurysm that was initially detected on cardiac echocardiogram. A large left renal AVF was detected incidentally on the CT scan. The fistula was successfully treated by ligation of the renal artery with resolution of pulmonary symptoms.
Assuntos
Fístula Arteriovenosa/etiologia , Nefrectomia/efeitos adversos , Artéria Renal/lesões , Veias Renais/lesões , Síndrome do Desconforto Respiratório/etiologia , Lesões do Sistema Vascular/etiologia , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Achados Incidentais , Ligadura , Readmissão do Paciente , Flebografia/métodos , Valor Preditivo dos Testes , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Reoperação , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/terapia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagemAssuntos
Artérias/lesões , Fístula Arteriovenosa/etiologia , Biópsia Guiada por Imagem/efeitos adversos , Vértebras Lombares/irrigação sanguínea , Veias Renais/lesões , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/etiologia , Adolescente , Artérias/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/terapia , Ecocardiografia Doppler em Cores , Embolização Terapêutica , Dor no Flanco/etiologia , Hematoma/etiologia , Humanos , Masculino , Veias Renais/diagnóstico por imagem , Espaço Retroperitoneal , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapiaAssuntos
Fístula Arteriovenosa/etiologia , Biópsia/efeitos adversos , Rim/patologia , Artéria Renal/lesões , Veias Renais/lesões , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Humanos , Hipertensão/etiologia , Imageamento Tridimensional , Masculino , Radiografia , Artéria Renal/diagnóstico por imagem , Insuficiência Renal Crônica/patologia , Veias Renais/diagnóstico por imagemAssuntos
Falso Aneurisma/terapia , Fístula Arteriovenosa/terapia , Biópsia/efeitos adversos , Embolização Terapêutica/métodos , Rejeição de Enxerto/patologia , Hematoma/etiologia , Rim/patologia , Complicações Pós-Operatórias/terapia , Artéria Renal/lesões , Veias Renais/lesões , Transplantes/patologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/patologia , Falso Aneurisma/etiologia , Angiografia/métodos , Fístula Arteriovenosa/etiologia , Cateterismo , Feminino , Hematoma/diagnóstico por imagem , Hematúria/etiologia , Humanos , Transplante de Rim , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVE: To evaluate the outcomes of robotic partial nephrectomy (RPN) for solitary kidney in a large multicenter series. MATERIALS AND METHODS: Medical records of 886 consecutive patients who underwent RPN at 5 academic institutions from May 2007 to May 2012 were retrospectively analyzed. Data were prospectively collected in an Investigational Review Board-approved protocol. Experienced robotic surgeons performed all operations. Patient demographics, functional, perioperative, and early oncologic outcomes were analyzed. RESULTS: A total of 26 patients with a solitary kidney were identified and included in the analysis; of these, 16 (62%) had solitary kidneys secondary to a previous malignancy. Perioperative outcomes included a median warm ischemia time of 17 minutes (interquartile range, 12, 28 minutes). Only 2 intraoperative complications occurred. One was a renal vein injury and one an aortic vessel tear, and both patients required intraoperative blood transfusions. No conversions to laparoscopy or open surgery occurred. There were 3 postoperative complications (11.5%). Median follow-up was 6 months (interquartile range, 5, 9.7 months). Postoperative renal function did not change significantly as measure by estimated glomerular filtration rate (-15.8%; P=.13). None of the patients required dialysis. Positive margins occurred in 1 patient, with 73% of patients having a renal cell carcinoma. CONCLUSION: We report a multi-institutional series of RPN in patients with solitary kidney presenting with small renal masses. Our findings suggest that RPN represents a feasible treatment option in this specific population by offering reliable preservation of renal function, low surgical morbidity, and early oncologic safety in the hands of experienced robotic surgeons.
Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Insuficiência Renal Crônica/fisiopatologia , Idoso , Aorta/lesões , Carcinoma de Células Renais/patologia , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Rim/cirurgia , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Nefrectomia/efeitos adversos , Veias Renais/lesões , Estudos Retrospectivos , Robótica , Isquemia QuenteRESUMO
We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9 ± 19.3 and 28.2 ± 7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7 ± 23.4 and 24.2 ± 6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8 ± 17.1 and 33.6 ± 5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.
Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Tempo de Internação , Ligadura , Pessoa de Meia-Idade , Veias Renais/lesões , Instrumentos Cirúrgicos , Grampeamento CirúrgicoRESUMO
We report a case involving the surgical removal of a Günther Tulip filter with symptomatic caval penetration after an unsuccessful attempt at percutaneous retrieval in a 32-year-old man with recurrent deep vein thrombosis. He presented with acute right flank pain a day after the attempted retrieval of the filter. An abdominal radiograph before surgical removal of the filter showed tilting and splaying of the filter, which was suggestive of caval penetration. Contrast-enhanced computerized tomography confirmed caval penetration of the filter legs into the retroperitoneal space, right renal vein, and duodenum associated with a small retroperitoneal fluid collection. Surgical removal of the filter by a transperitoneal approach resulted in resolution of the flank pain.
Assuntos
Remoção de Dispositivo , Migração de Corpo Estranho/cirurgia , Lesões do Sistema Vascular/cirurgia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/cirurgia , Trombose Venosa/terapia , Ferimentos Penetrantes/cirurgia , Adulto , Meios de Contraste , Duodeno/lesões , Duodeno/cirurgia , Dor no Flanco/etiologia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Desenho de Prótese , Recidiva , Veias Renais/lesões , Veias Renais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/etiologiaRESUMO
BACKGROUND: We propose a revision of the original 1989 renal organ injury system established by the American Association for the Surgery of Trauma based on our institution's>25-year longitudinal experience. Our goal is to expand the current grading system to include segmental vascular injuries and ureteral pelvic injuries and to establish a more rigorous definition of severe grade IV and V renal injuries. METHODS: We retrospectively reviewed our prospectively gathered contiguous renal database of 3,580 renal injuries to describe a revised renal grading injury scale based on clinical renal salvage outcomes. We focused on the mechanism of injury, the stability of the patient, radiographic imaging, associated nonrenal injuries, and clinical salvage outcome data. RESULTS: No changes were made in the definition of grade I to III injuries. The revised grade IV classification includes all collecting system, renal pelvis injuries and segmental arterial and/or venous injuries. The revised grade V classification is limited to main renal artery and/or vein injuries, including laceration, avulsion, and thrombosis. We compared the nephrectomy rate and clinical renal salvage rate between the original 1989 renal organ injury system with our revised renal injury staging classification. CONCLUSION: The revised renal injury staging classification provides complete and clear definitions of renal trauma while still performing its fundamental objective to reflect increasingly complex renal injuries. Uniform language and classification of renal injuries will enhance discussion, clinical investigation, and research of renal trauma.
Assuntos
Escala de Gravidade do Ferimento , Rim/lesões , Traumatologia/normas , Humanos , Rim/irrigação sanguínea , Artéria Renal/lesões , Veias Renais/lesões , Sociedades Médicas/normas , Estados Unidos , Ureter/lesões , Ferimentos e Lesões/classificação , Ferimentos não Penetrantes/classificação , Ferimentos Penetrantes/classificaçãoRESUMO
Recently, ultrasound-guided percutaneous renal biopsy has been used in the diagnosis of renal diseases. Development of an arteriovenous fistula (AVF), which is one of the post-biopsy complications, is not frequently encountered. AVFs are usually asymptomatic; however, they may lead to serious outcomes. We report a 21-year-old patient, who had been on dialysis for 5 years. Due to high blood pressure (230/160 mmHg) and a thrill in the lumbar area detected on physical examination, Doppler examination was performed and a renal AVF was detected. Because the patient had a history of renal biopsy 5 years previously, the fistula was thought to be secondary to the biopsy. After embolization of the AVF, renal functions improved enough to terminate dialysis treatment.
Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica , Testes de Função Renal , Artéria Renal/lesões , Diálise Renal , Veias Renais/lesões , Angiografia , Fístula Arteriovenosa/diagnóstico , Biópsia/efeitos adversos , Humanos , Masculino , Ultrassonografia Doppler , Ultrassonografia de Intervenção , Adulto JovemRESUMO
Although catheter angiography remains the accepted gold standard for imaging of the renal vascular system, rapid progress in cross-sectional imaging techniques has caused a paradigm shift in many diagnostic algorithms toward noninvasive techniques such as computed tomographic angiography (CTA). CTA's cross-sectional imaging techniques provide an opportunity for comprehensive renal investigation that would be impossible with angiography alone. While other competing noninvasive technologies such as ultrasound and magnetic resonance angiography can be used successfully in renal imaging, the benefits of CTA are substantial, including high spatial and temporal resolution, widespread availability, implantable device compatibility, and easy technical reproducibility. This article describes the technical considerations relevant to CTA of the renal vascular system, postprocessing algorithms for volumetric data, and numerous specific applications.