Renal Arteries Revisited: Anatomy, Pathologic Entities, and Implications for Endovascular Management.

The renal arteries (RAs) are important vessels that usually arise from the abdominal aorta and supply the kidneys; thus, these arteries play a vital role in physiologic functions such as hemofiltration and blood pressure regulation. An understanding of the basis for embryologic development and the frequently variable anatomy of the RAs is necessary to fully appreciate the range of diseases and the implications for procedural planning. Hemorrhage from an RA is relatively common and is typically traumatic or spontaneous, with the latter form often seen in association with underlying tumors or arteriopathy. Accurate diagnostic evaluation of RA disease due to conditions such as atherosclerosis, fibromuscular dysplasia, vasculitis, aneurysm, arteriovenous shunt, embolic disease, and dissection is dependent on the use of multimodality imaging and is essential for selecting appropriate clinical management, with endovascular therapy having a key role in treatment. Surgical considerations include extra-anatomic renal bypass, which remains an important treatment option even in this era of endovascular therapy, and RA embolization as an adjunct to tumor surgery. A novel area of research interest is the potential role of RA denervation in the management of refractory hypertension. ©RSNA, 2021.

Hepatorenal Bypass for Renal Salvage: A Forgotten Option in the Endovascular Era.

INTRODUCTION:: In this era of rapidly expanding endovascular techniques, the use of hepatorenal bypass as treatment for a critically compromised renal perfusion has largely been forgotten. This article highlights the benefits of the technique both as a bailout strategy following complications from angioplasty and as a primary treatment in cases deemed unsuitable for endovascular intervention. MATERIALS AND METHODS:: Two patients are described whose renal viability was threatened by vascular compromise. One patient had a single functioning kidney with significant renal artery stenosis secondary to severe atherosclerotic disease and developed acute renal function deterioration following unsuccessful angioplasty. The second patient developed renal artery occlusion 3 years following open thoracoabdominal aortic aneurysm surgery. Both patients underwent successful hepatorenal bypass surgery and remain off dialysis 6 months after admission. RESULTS:: Both cases demonstrated the success of hepatorenal bypass with significant improvement in their renal function following open surgical repair. CONCLUSION:: Hepatorenal bypass, although now seldom used because of available endovascular alternatives, remains an effective method of treating complicated cases of threatened kidney secondary to vascular insult.