Aortoarteritis: A rare pulmonary-renal disease

Takayasu arteritis (TAK) is an autoimmune disease majorly affecting young females. It alters the vascular wall, resulting in stenosis, occlusion, or dilatation. It has no distinct clinical manifestation. Here, we present the case of an 18-year-old girl who presented with generalized tonic-clonic seizure and hypoxia. Blood investigations showed deranged urea and creatinine values. Computed tomography angiography revealed bilateral artery occlusion, decreased kidney size, and pulmonary artery dilatation, confirming generalized vascular disease that caused hypertension and ischemic nephropathy in the patient. Our case represents a rare autoimmune disease, leading to pulmonary hypertension and renal artery stenosis. TAK should be considered as a differential diagnosis in young female patients presenting with pulmonary as well as renal signs and symptoms, especially if there is discrepancy in blood pressure levels in all limbs.

Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects / Rim esquerdo unilateral sem rotação com variações vasculares e de ureter em cadáver: relato de caso com aspectos embriológicos e educacionais

Abstract The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Resumo Os rins e o ureter são estruturas retroperitoneais localizadas na parte superior do sulco paravertebral, inclinados contra as estruturas laterais das duas vértebras torácicas inferiores e das três vértebras lombares superiores. Assim, as superfícies anteriores e posteriores estão nas porções anterolateral e posteromedial, respectivamente. As anomalias congênitas do trato urinário frequentemente são causas subjacentes de patologias renais, e 40% delas ocorrem devido a variações no local, formato e tamanho dos rins, cálices, ureter ou bexiga. Este relato de caso descreve a presença de rim esquerdo unilateral sem rotação com variações vasculares e de ureter encontradas durante uma dissecção de cadáver rotineira com graduandos de Medicina. As alterações na rotação do rim e a sua relação com as estruturas no hilo têm grande importância clínica durante procedimentos cirúrgicos como a nefrectomia parcial, a cirurgia poupadora de néfrons e o transplante renal.

Bilateral multiple renal arteries with an extra-aortic origin and quadruple testicular veins / 대한해부학회지

Persisting subcardinal vein associated with unilateral ectopic pelvic kidney / 대한해부학회지

A Computed Tomography (ct) Evaluation Of Renal Artery Evaluation In Healthy Adult North Indian Population

Aims and Objective: In 70% of normal population, each kidney is applied by a single renal artery. Renal arteriesare known to present with wide range of anatomic variations. These variations are frequently related to thenumber of renal arteries, level of origin, length, diameter and branching pattern. Renal transplantation is theonly curative option for end stage renal disease. Laparoscopic donor nephrectomy has become the preferredtechnique in renal transplant programs. The transplant surgeon requires at least 2 cm of renal artery lengthbefore hilar branching and diameter of 3 mm to ensure adequate vascular anastomosis. Therefore, a priorknowledge of number of renal arteries, the length and diameter of renal artery and branching pattern has becomeessential for renal transplant surgeons.Material and Methods: One hundred prospective healthy voluntary kidney donors (16 males and 84 females;mean age of 43.5±10.42 years), were evaluated for the renal artery anatomy by MDCT and CT angiography as partof preoperative assessment prior to donor nephrectomy. The number, level of origin, the diameter and length ofrenal artery on either side was recorded.Results: Single renal artery was present in 75.5% kidneys. The right MRA originated from aorta at the level of L1vertebra in 78% cases and left MRA originated from aorta at lower level( L2 vertebra) in 47% of cases.The meanlength of left and right renal artery was 26.2±10.6 mm and 29.6±12.8 mm respectively; mean diameter was5.8±1.2 mm and 5.2±1.0 mm respectively. The difference between length and diameter of both sides was statisticallysignificant. The mean diameter of left MRA was 5.8±1.2 mm and right MRA 5.2±1.0 mm and difference wasstatistically significant (p=0.001). Both in males and females the mean diameter of left MRA was more than thatof right MRA.Conclusion: In the present study it was observed that single renal artery was present in 75.5% kidneys. The rightMRA originated from aorta at a higher level compared to left MRA. The left renal artery was shorter and widerthan right renal artery. In 22.5% cases the length of renal artery was less than 2.0 cm.

Variantes anatómicas de origen de los ramos viscerales de la arteria aorta descendente infradiafragmática / Anatomical variants of the origin of the infra-diaphragmatic descendent aorta artery visceral branches

Introducción: la arteria aorta es el mayor de los vasos elásticos del cuerpo humano. Las variantes a la norma anatómica de los ramos arteriales son formaciones que deben ser reconocidas por sus implicaciones durante las cirugías. Objetivo: determinar las variantes de origen a la norma anatómica de los ramos viscerales de la arteria aorta infradiafragmática. Materiales y Métodos: se realizó un estudio observacional, descriptivo y prospectivo en 44 pacientes, mayores de 16 años, fallecidos por causas naturales en el Hospital Provincial Celia Sánchez, Manzanillo. Se observó, en el curso de la necropsia, el origen de los diferentes ramos viscerales de la arteria aorta infradiafragmática. Resultados: las variantes a la norma anatómica se constataron en el 45,45 % de los bloques predominando en el sexo femenino (59,09 %). Las arterias renales fueron las que más variantes a la norma anatómica presentaron, con el 57,69 % del total. En las arterias suprarrenales medias y gonadales se encontraron el 19,23 % del total de variantes. El tronco celiaco fue el único ramo visceral impar en el que se constataron variantes a la norma anatómica (11,54 %). El 11,54 % de las variantes se corresponden con bifurcaciones anómalas de la arteria aorta. Conclusiones: las variantes de origen a la norma anatómica, de los ramos viscerales de la arteria aorta infradiafragmática, tienen una frecuencia alta. Las mayores variantes se localizan en las arterias renales no encontrando variantes en las arterias mesentéricas. El conocimiento de estas variantes es importante en procedimientos quirúrgicos.

Background: aorta artery is the biggest of the human body elastic vases. The variants of the arterial branches anatomic norm are formations that should be recognized, because of their implications during surgeries. Aim: to determine the origin variants to the anatomic norm of the infra-diaphragmatic aorta artery visceral branches. Materials and Methods: an observational, descriptive, prospective study was carried out in 44 patients, elder than 16 years old, who died due to natural causes in the Provincial Hospital Celia Sanchez, Manzanillo. The origin of the different infra-diaphragmatic aorta artery visceral branches was observed in the course of the necropsy. Outcomes: variants to anatomic norm were stated in 45.45 % of the blocks, predominating in the female gender (59.09 %). Renal arteries were the ones presenting more variants to anatomic norm, with 57.69 % of the total. 19.23 % of the total of variants was found in the medial suprarenal and gonadal arteries. The celiac trunk was the only odd visceral branch where variants to anatomic branches were found (11.54 %). 11.54 % of the variants correspond to aorta artery anomalous bifurcations. Conclusions: the origin variants to anatomic norm of the infra-diaphragmatic aorta artery visceral branches have a high frequency. The biggest variants are located in the renal arteries. Variants were not found in the mesenteric arteries. These variants knowledge is important in surgical procedures.

Extra Hilar Branching of Renal Arteries: An Anatomical Study.

Introduction: The objective of this study was to observe the patterns of different arteries that supply the kidneys. The kidney has a segmental distribution of arteries. The kidneys are divided into five vascular segments. The arteries that arise from the aorta above or below the main renal artery and reach the hilum are called accessory renal arteries. They are persistent embryonic lateral splanchnic arteries. Accessory renal arteries may arise from the celiac or superior mesenteric arteries, near the bifurcation or from the common iliac arteries. The present study has attempted to find out accessory, and aberrant arteries to kidneys with review of literature. Materials and Methods: The study was done on 52 kidneys randomly selected from cadavers that were used for the purpose of teaching in the department of Anatomy at P.E.S Medical College. The kidneys were removed from the cadavers en-block with the arteries and veins intact. The renal artery was observed for its pattern of branching. Observations and Discussion: The pre-hilar branching pattern was absent only in six kidneys out of the 52 kidneys selected. The branches given before entering the hilum were either in the form of a fork pattern or a ladder pattern in the remaining 46 kidneys. The fork pattern wherein the branches arose from a single point was found in 42 kidneys. The ladder patterns were seen in two posterior segment arteries and two anterior segment arteries. The anterior division often showed the fork patterns which were either duplicate or triplicate outside the hilum more proximally, with further division into duplicate or triplicate terminal branches closer to the hilum but significantly outside.

Morphometric evaluation of the kidney and its main renal artery.

Background: With the increasing incidence of renal transplantations and advent of modern imaging techniques in the current era, the knowledge of renal artery variations in their position of origin from abdominal aorta, level of origin from the superior mesenteric artery, pattern of their division towards the renal hilum, and the additional branches from the renal arteries should be well known for preparing renovascular surgical and radiological interventions. Methods: Fifty specimens from 25 adult human embalmed cadavers were taken from the department of anatomy and were studied by dissection method. Morphometric data of the specimens dissected were recorded using vernier calipers. Results: Though morphometric analysis of both the kidneys was studied, it shows no significance from earlier studies. Accessory renal arteries were noted in 24% of cases with equal incidence on both sides. Within accessory, hilar type was most common (14%), followed by inferior polar in 12% and superior polar in 2% of specimens. Accessories in 28.5% specimens gave rise to gonadal arteries and 7.3% specimens to inferior phrenic artery. Conclusion: The results suggest that there are a large number of anatomical variations in the vascularisation of the kidney. The most common incidence is the occurrence of accessory renal arteries. It was rarely found that superior and inferior polar arteries originated from the renal artery. The renal artery diameter is a factor which should be considered as predicting the presence of additional renal arteries.

Accessory renal arteries: a case report.

During dissection of abdomen by the undergraduate medical students three accessory renal arteries were observed on the right side. The superior accessory artery was a small vessel arising from aorta just above the normal renal artery. It entered the anterior surface of kidney just below the upper pole. The middle and inferior arteries were caudal to the normal renal artery. The middle artery was arising from testicular artery and entered the anterior surface of kidney below the hilum. The inferior artery was arising from aorta just above its bifurcations and entered the lower pole of kidney. The importance of accessory renal arteries in surgical procedures of the posterior abdominal wall and renal transplantation are discussed.

Renal vascular morphology and their significance in predicting accessories.

Background: Renal arteries presented great morphological variations in their emergence, frequency, and ramification pattern. Therefore, this study was aimed to establish the possible relationship between the caliber of the renal artery and existence of the accessory renal arteries. Methods: Fifty kidneys obtained from fresh cadavers were subjected for corrosion cast to determine the diameter of main and accessory renal arteries. Results: In our study, we found that the incidence of single accessory renal artery (24%) was higher than the presence of two or more accessory arteries (4%) from the aorta. However, no significant difference was observed in the number of accessory renal arteries with respect to right and left side. Superior polar type of accessory renal artery was seen only on the left side in 2% of the specimens, and inferior polar arteries were found in 6% of the specimens on both the sides. The hilar type of accessory renal arteries were found in 8% and 6% of the cases on right and left sides respectively. Conclusion: The diameter of the main/principle renal artery in kidney presenting the accessory renal arteries was significantly less than that of the kidney with single renal artery.

Variantes anatómicas de las arterias polares del riñón / Anatomic variants of the polar arteries of the kidney

Introducción: la irrigación arterial del riñón, clásicamente descrita, se produce a partir de la arteria renal y sus dos ramas terminales exclusivamente. El objetivo de la investigación fue determinar la presencia y distribución de las arterias renales polares. Métodos: se realizó un estudio cuantitativo, longitudinal, prospectivo, observacional y descriptivo, en 37 bloques, provenientes de cadáveres sin cirugías aortorenales ni malformaciones congénitas renoureterales demostrables, en el Hospital Provincial Clínico Quirúrgico Docente Celia Sánchez Manduley, de Manzanillo, provincia Granma. Los bloques fueron lavados, fijados y disecados por el método macroscópico directo. Resultados: las arterias polares fueron más frecuente en el sexo masculino y en el lado derecho, demostrándose su presencia en 16 casos (43,24 %), donde 9 presentaban, al menos, una arteria polar superior; 3 presentaron, al menos, una arteria polar inferior; y 4 casos presentaron, al menos, una de cada arteria polar. Predominó el origen de ambas arterias polares como ramo directo de la arteria aorta. Conclusiones: las arterias polares no constituyen variantes anatómicas de rara presencia y su conocimiento es imprescindible en el planeamiento de la cirugía excerética y reconstructiva nefrourológica.

Background: the kidney arterial irrigation, as it is classically described, occurs from the renal artery and its two terminal branches exclusively. The aim of this research was to determine the presence and distribution of the polar arteries. Method: a quantitative, longitudinal, prospective, observational and descriptive study was carried out on 37 tissue samples from dead bodies without aortic renal surgeries or congenital demonstrable reno-ureteral malformations at “Celia Sánchez Manduley” Teaching Provincial Clinical-Surgical Hospital of Manzanillo, Granma. The samples were washed, fixed and dissected through the direct macroscopic method. Outcomes: The polar arteries were more frequent in the male sex and on the right side, being found in 16 cases (43.24%), 9 of which presented, at least, a superior polar artery; 3 presented at least an inferior polar artery; and 4 cases presented at least one of each type of polar artery. The origin of both polar arteries as a direct branch of the aorta was predominant. Conclusions: The polar arteries are not anatomical variants of rare presence, and our knowledge of them is of vital importance in planning the removing and reconstructive nephro-urologic surgery.

Cadaveric study of accessory renal arteries and its surgical correlation.

A thorough knowledge of the accessory renal arteries has grown in importance with the increasing number of renal transplants and other uroradiological procedures. The literature indicates that multiple renal arteries are found in 9-75% cases. Normal anatomy describes each kidney receives irrigation from single renal artery which arises from abdominal aorta at the level L1-L2 vertebrae just below the superior mesenteric artery. Renal artery variations include their origin, number and course. The most common is the presence of additional vessels (accessory arteries) arising above the usual trunk is more frequent than one arising below. The accessory renal arteries are always end arteries. The kidneys may receive a single artery although each organ may equally be supplied by as many as six end arteries. The right and left renal arteries may arise from the aorta by a common stem or arise at lower point than usual in which case the kidneys lie below their usual position. There may be several renal arteries on each side or the renal artery may divide close to its origin into several branches. Current literature reports great variability in renal blood supply, the number of renal arteries mentioned being the most frequently found variation. Normal renal arterial information is useful not only for planning and performing of endovascular, laparoscopic uroradiological procedures and renal transplants. In order to facilitate the clinical approaches, we studied renal arterial pattern in 25 formalin fixed cadavers, on 50 kidneys during the period of one year. The purpose of this present study was to establish the incidence of accessory (aberrant) renal arteries in human cadavers and also discuss its surgical correlation during uroradiological procedures and angiographic interventions.

Spontaneous Renal Artery Dissection: An Important Differential Diagnosis for Sudden Onset of Back Pain / General Medicine

Spontaneous renal artery dissection (SRAD) is uncommon and hence diagnosis is often delayed when ideally a quick one is preferred. We report a case of a 53 year-old male, with a known history of nephrolithiasis, who was admitted into hospital complaining of sudden onset left-sided back pain. Ultrasound showed a right-sided calculus instead of the expected left. A subsequent contrast computed tomography (CT) scan was done showing an infarcted segment of the left kidney. Further investigation with angiography and intravascular ultrasound (IVUS) revealed the presence of two left renal arteries with the distal originating left renal artery having dissected.

Valoración en un solo paso del potencial donante renal: Angiografía y urografía por RM con correlación quirúrgica / One-step MR angiography and urography in the evaluation of potential renal living donors.

Objetivos. Evaluar el rendimiento diagnóstico de la angiografía renal (ARM) y urografía (URM) por Resonancia Magnética (RM) en potenciales donantes de riñón mediante la correlación con hallazgos quirúrgicos. Materiales y Métodos. Se evaluaron 55 potenciales donantes mediante protocolo angiográfico y urográfico en múltiples fases en un resonador de 1,5 T. La ARM valoró la existencia de variantes anatómicas o alteraciones estructurales arteriales o venosas y la URM valoró el parénquima renal y el sistema colector en fases nefrográfica y excretora. Los resultados fueron comparados con hallazgos quirúrgicos. Resultados. La correlación se realizó en 42 donantes efectivos. En ellos, se observó una especificidad de la ARM del 94% y una exactitud diagnóstica del 93%. Se identificaron variantes anatómicas y alteración estructural arterial en el 29% de los pacientes. La valoración venosa y urográfica de la RM resultó concordante quirúrgicamente en todos los casos. Conclusión. Las imágenes de RM proveen un método seguro y eficaz para la valoración prequirúrgica renal de forma integral en potenciales donantes de riñón.

Objectives. To evaluate diagnostic accuracy of renal MRangiography(MRA) and MR- urography (MRU) in the assessment of normal anatomy and renal vascular pathology in potential renal living donors compared with surgical findings. Materials and Methods. Evaluation of 55 potential living donors performing one-step MR angiography and MR urography in a 1.5 T magnet. MRA evaluated the presence of anatomic variants or arterial or venous pathologic conditions. MRU depicted renal parenchyma anatomy and collector system. These results were compared with surgical findings. Results. MRA and MRU findings were actually compared with surgical findings in 42 effective donors. MRA specificity was 94 % and diagnostic accuracy was 93 %. Anatomic variants and arterial structural abnormalities were detected in 29 % of patients. Venous and excretory surgical findings were consistent in 100 % of cases. Conclusion. One-step MRA and MRU constitutes an accurate method for pre-operative assessment of renovascular and excretory anatomy in potential living donors.

Niveles de origen de las arterias renales y mesentérica superior respecto a la columna vertebral en individuos chilenos: estudio por tomografía computarizada helicoidal / Origin levels of the renal and superior mesenteric arteries in relation to the vertebral column in Chilean individuals: helicoidal computed tomography study

El conocimiento de las variaciones arteriales es importante tanto para el diagnóstico como para los procedimientos quirúrgicos a realizar en el abdomen. Esta investigación se realizó con el propósito de determinar a través de angio TAC, los niveles de origen y número de las arterias renales y mesentérica superior, con respecto a los componentes de la columna vertebral. Para ello, utilizamos los registros angiográficos de 31 pacientes, adultos, chilenos, de ambos sexos, en los cuales localizamos los puntos de origen de las arterias mencionadas, para lo cual dividimos la altura de las vértebras en tercios, considerando además al disco intervertebral. En 26 pacientes, la arteria renal en ambos lados se presentó única; en el lado derecho, la arteria renal se presentó doble en 2 personas y en el izquierdo en 3. La arteria renal derecha se originó a nivel de la vértebra L1 en 11 casos; a nivel del disco intervertebral entre L1 y L2 en 7; a nivel de la vértebra L2 en 10; entre L2 y L3 en 2. La arteria renal izquierda se originó a nivel de L1 en 9 casos, entre L1 y L2 en 6, y, de L2 en 12. La arteria mesentérica superior fue única en todos los casos, localizando su nivel de origen siempre craneal al origen de las arterias renales. Se originó a nivel de la vértebra L1 en 16 casos; a nivel de L2 en 8. Se consideraron también niveles más específicos de origen en relación a una subdivisión de las vértebras. Los resultados obtenidos complementarán el conocimiento sobre estas arterias, aportando a la anatomía quirúrgica de la región.

The knowledge of the arterial variations is very important for the diagnosis and the surgical procedures. The purpose of this study was determine the number and the origin levels of the renal and superior mesenteric arteries in relation to the vertebral bodies. For this, we used the angiographies of 31 patients, Chileans, adult, of both sexes. The angiographies were obtained by Helicoidal Computed Tomography, in these we localized the origin points of the mentioned arteries. We divided the vertebral bodies in three parts, superior, middle and inferior, considering too the intervertebral disc. In 26 patients, in both sides the renal artery was only; in the right side it was double in 2 patients and in the left side in 3. The right renal artery originated from the level of L1 vertebra in 11 cases; from the level of L1-L2 intervertebral disc in 7; from the level of the L2 vertebra in 10 and from the level of the L2-L3 intervertebral disc in 2. The left renal artery originated from the level of the L1 vertebra in 9 cases; from the level of the L1-L2 intervertebral disc in 6; from the level of the L2 vertebra in 12 and from the level of the L2-L3 intervertebral disc in 2. The superior mesenteric artery was only in all cases; it origin level was always cranial to the renal arteries origin. The origin level of the superior mesenteric artery was observed in relation to the L1 vertebra in 16 cases and to the level of the L2 vertebra in 8. We considered specifical origin levels associated to the vertebral body division. The results of this study will complete the knowledge of these arteries and are a contribution to the surgical anatomy of abdominal region.

Multiple Renal Artery Anastomosis in Kidney Transplantation: Clinical Outcome / 대한이식학회지

PURPOSE: Kidney transplantation with multiple renal arteries has been associated with higher incidence of vascular and urologic complications. Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively, so it would be clearly in the best interests to the recipients whether to include these individuals as organ donor candidates. There is an increasing requirement to use such kidneys and it is not unusual trend any more. Some authors insist the vessel anastomosis time (2nd warm ischemia time) exceeding 35 minutes may attribute to the development of acute tubular necrosis (ATN). There are various methods in anastomosis of multiple renal arteries but vascular and urologic complications depend on the technical surgical skills or methods of the vascular anastomosis. METHODS: A retrospective study was assessed for 454 kidney transplantations performed in the department of surgery, Maryknoll Medical Center between August, 1990, and May 2007. Study groups are divided into four groups according to anastomosis METHODS: Group I, a single-artery anastomosis (n=387) and others, multiple-artery anastomosis (Group II~Group IV) includes extracorporeal (Group II), intracorporeal (Group III) artery anastomosis, and polar artery ligation (Group IV). RESULTS: Among those groups, there are no significant differences in 2nd warm ischemia time, serum creatinine level, recipient and graft survival rate, acute tubular necrosis, acute rejection rate, blood pressure change, and urologic and vascular complication. CONCLUSION: Kidney transplantation of multiple renal arteries is not a difficult challenge any more and it is now more important to find out the better way and better result.

Arterias Renales Múltiples / Multiple Renal Arteries

El conocimiento de las variaciones de la irrigación renal es de mucha importancia debido al incremento de transplantes renales y cirugías de reconstrucción vascular. La literatura muestra que generalmente hay una arteria renal para cada riñon, sin embargo pueden observarse variaciones de origen y de número. Presentamos dos casos de arterias renales triples izquierdas, en muestras pertenecientes a la Unidad de Anatomía de la Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca. En uno de los casos, el origen de la arteria renal R1 (superior) se efectuó a nivel de la parte inferior del origen de la arteria mesentérica superior, la que después de un trayecto de 30 mm se dividió en dos ramas menores de calibre similar, que ingresaron en el hilio renal por delante de la vena renal. La rama R2 (media) se originó 4 mm distal a la anterior, correspondiendo a una rama posterior que también ingresó en el hilio; la rama R3 (inferior) lo hizo 23 mm distal a la R2. Esta última penetró en el riñon inmediatamente por debajo de la incisura del seno renal. En el segundo caso, hay diferencias con respecto al anterior, ya que la rama R1 y la R3 penetraron en el hilio renal, en cambio la R2 tiene un trayecto descendente y penetra de forma similar al R3 del caso anterior. El conocimiento de estas arterias múltiples es necesario y es de importancia consideraR1as durante la intervenciones quirúrgicas que involucren a este órgano.

Due to increase of renal transplants and vascular reconstructions, the knowledge of variations of renal arteries is very important. The literature indicates that each kind have one artery, however sometimes there are origin and number variations. We describe in this article two cases with three arteries in the left side, found in the Anatomy Unit from Health Sciences Faculty, Universidad Católica del Maule, Talca, Chile. In one case, the origin of renal artery R1 (superior) from abdominal aorta, was to level of superior mesenteric artery origin. This R1 following a 30 mm trajectory divided in two minor branches of similar diameter and entered in the hilus passing in front of the renal vein. The origin of R2 (middle) was distal 4 mm to the R1, corresponding to a posterior branch that entered in the renal hilus and the R3 (inferior) originates distal 23 mm to the R2. This last artery entered in renal cortex, inferior to the renal sinus notch. In the second case, there were diferences with respect to the first case because R1 and R3 entered in the hilus, and, R2, with descendent course entered in renal cortex, similar to R3 of first case. The knowledge of these multiple arteries is necessary and should be kept in mind before and during surgery involving the renal region.

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization.

Transcatheter Arterial Embolization of Renal VX-2 Carcinoma: Ethiodol-Ethanol Capillary Embolization Combined with Carboplatin

OBJECTIVE: We wanted to determine whether transcatheter Ethiodol-based capillary embolization in combination with carboplatin could improve the efficiency of a 1:1 Ethiodol-ethanol mixture (EEM) to ablate kidneys that been inoculated with VX-2 carcinoma. MATERIALS AND METHODS: The right kidney in 34 New Zealand white rabbits were inoculated with fresh VX-2 tumor fragments. One week later, the kidneys were subjected to transarterial treatment (4-5 rabbits/group): Saline infusion (Group 1); carboplatin infusion (5 or 10 mg, Groups 2A and 2B); carboplatin-Ethiodol (CE) alone (Group 3) and followed by main renal artery occlusion with ethanol (RAO) (Group 4); carboplatin-EEM (C-EEM) followed by RAO (Group 5); carboplatin infusion followed by EEM plus RAO (Group 6); and EEM followed by RAO (Group 7). The animals were followed for up to 3-weeks. The treated kidneys were evaluated angiographically and macroscopically. The kidneys that showed successful embolization macroscopically were entirely cut into serial sections, and these were examined microscopically. Histologically, the kidneys were evaluated on the basis of the residual tumor found in the serial sections. RESULTS: The results obtained with carboplatin infusion alone (Groups 2A and 2B) and CE without RAO (Group 3) were similar to those of the control animals (Group 1). Kidneys from Groups 4-7 demonstrated macroscopically successful embolization with histologically proven complete renal parenchyma infarction; however, some residual tumor was evident in all but one animal. CONCLUSION: None of the Ethiodol-based modalities combined with locoregional carboplatin were more efficacious for tumor ablation than EEM alone.

Emergent endovascular embolization of iatrogenic renal vascular injuries / 介入放射学杂志

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)