Simultaneous Compression of the Celiac Trunk, Superior Mesenteric Artery, and Renal Arteries by the Median Arcuate Ligament: About One Case

Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.

Effects of renal artery stenosis on realistic model of abdominalaorta and renal arteries incorporating fluid-structureinteraction and pulsatile non-Newtonian blood flow

The effects of the renal artery stenosis （RAS） on the blood flow and vessel walls are investigated. The pulsatile blood flow through an anatomically realistic model of the abdominal aorta and renal arteries reconstructed from CT-scan images is simulated, which incorporates the fluid-structure interaction （FSI）. In addition to the investigation of the RAS effects on the wall shear stress and the displacement of the vessel wall, it is determined that the RAS leads to decrease in the renal mass flow. This may cause the activation of the renin-angiotension system and results in severe hypertension.

Accessory renal arteries-a source of hypertension:A case report

BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.

Evaluation of renal artery stenosis using color Doppler sonography in young patients with multiple renal arteries

Background Some individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography （CTA） and magnetic resonance angiography （MRA）. This study reported the application of color Doppler sonography （CDS） in the detection of severe stenosis in one of the multiple arteries. Methods Patients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities （PSV） of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography （DSA）. Results Four children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis 〉70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns. Conclusion Non-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in younq patients.

Visceral and renal arteries stenosis associated with Takayasu arteritis

Takayasu arteritis （TA） is a nonspecific granulomatous inflammatory arteriopathy of unknown cause that results in occlusive obliteration or less commonly aneurysm degeneration of large and medium-sized elastic arteries. Most descriptions of this disease have emphasized the ＂pulseless＂ syndrome, however, less attention has been paid to involvement of other segments of the aorta, renal arteries, and in particular the visceral arteries. We reported a case of type Ⅱ TA, in which both the visceral and the bilateral renal arteries were involved.

Hemodynamics in renal arteries with partial coverage after endovascular aneurysm repair affected by renal orientations

Endovascular aortic repair(EVAR)has been increasingly used to treat abdominal aortic aneurysm(AAA)due to its lower mortality and shorter recovery time.However,the complications caused by renal artery coverage remained a major concern.In this study,three types of renal orientation and five types of partial renal coverage degree were adopted to numerically investigate the flow pattern,wall shear stress distribution,and blood perfusion during a cardiac cycle.The results show that as for the mild partial coverage(=<30%),the renal artery with a downward orientation suffered fewer unfavorable wall shear stress(WSS)distribution and more blood perfusion.It should be noted that the renal artery with horizontal orientation suffered more unfavorable WSS distribution.In terms of severe coverage(≥50%),all of the renal arteries displayed highly disturbed wall shear distribution,resulting in a significant reduction in blood perfusion It was interesting to note that the artery with an upward orientation had a smaller rate of reduction in blood perfusion.It can be concluded that as for the mild renal coverage after EVAR,renal arteries with downward orientation may have the advantage of reducing the possibility of renal occlusion,while renal arteries with horizontal orientation may increase the unfavorable wall shear distribution.On the other hand,as for serious coverage(≥50%),high risk of renal ischemia remains the main concern for all types of renal arteries due to highly disturbed wall shear distribution would significantly increase regardless of renal orientation.

Surgical treatment of left-sided renal carcinoma with grade II inferior vena cava tumour thrombus: a report and review of the literature

The surgical removal of renal cancer,along with the thrombectomy of the inferior vena cava tumour thrombus,represents a remarkable milestone in urological surgery.This procedure is not only technically demanding but also requires a high level of surgical expertise.Managing renal cancer combined with a vena cava tumour thrombus poses significant challenges,especially when dealing with combined grade Ⅱ-Ⅳ inferior vena cava tumour thrombus.The complexity of these cases is further exacerbated by the delicate anatomical structures involved and the need to preserve critical vessels while effectively removing the tumour.The Upper Urethral Tumour Treatment Centre of Weifang People's Hospital successfully treated a challenging case of left renal tumour combined with grade II inferior vena cava tumour thrombus.The surgical team,led by experienced urological surgeons,meticulously planned and executed the procedure,ensuring minimal trauma to the patient and complete removal of the tumour.This achievement not only demonstrates the hospital's commitment to providing state-of-the-art surgical care but also highlights the importance of continued research and training in urological oncology.The successful outcome of this case is a testament to the expertise and dedication of the medical team and offers hope to patients facing similar complex surgical challenges.

Anatomical Variations of Renal Artery in Patients Undergoing Computerized Tomographic Scan in Sudan

Anatomical Variations of Renal Vascular in Patients Undergoing Computerized Tomographic scan in Sudan, the total number of patients studied is 400, 202 (50.5%) males and 198 (49.5%) females, and their ages ranged between (3 - 94) years. The study showed mean of total samples of the width and length of right and left kidneys respectively measurements were 5.354 ± 0.948 and 5.571 ± 0.966 for width and 10.028 ± 1.3684 and 10.060 ± 1.5203 for length, the width and length for right renal artery 5.746 ± 1.2814 and 5.881 ± 1.1444 respectively and for left renal artery 5.894 ± 1.3175 and 4.961 ± 1.3175 respectively. Accessory renal artery is a common but a significant anatomical variant of the renal vascular system, due to its clinical importance. In our sample, the accessory renal artery presence was detected in 6% and displayed a greater variation on the right than the left side. Because this abnormality plays an important role in kidney transplantations, in radiological, vascular and urological interventions, a detailed presentation of accessory renal artery incidence was conducted, gathering from the literature a large number of relevant studies in order to create a classification according to population, gender, side and specimen. And the study concluded that the renal arteries present a broad spectrum of variability in their morphological expression regarding their length, diameter and entrance to the kidney parenchyma. The inferior polar renal artery was found same as the superior polar renal artery, additional arteries’ morphological expression was higher in men than women. This is statistically not significant and variation in the right side was found greater frequency than the left side.

Evaluation of Renal Artery Anatomical Variations Using Multi-Detector Computerized Tomographic Scan in Sudan

Evaluation of Renal vascular anatomical variations Using Multi-Detector Computerized Tomographic scan in Sudan, the total number of patients studied is 400, 202 (50.5%) male and 98 (49.5%) females, and their ages ranged between (3 - 94) years. The types of Accessory renal arteries were 1.8% (7/24) upper pole, 1.8% (7/24) lower pole and 2.5% (10/24) hilus. In males, 4 upper pole, 4 lower pole and 7 hilus. In females, 3 upper pole, 3 lower pole and 3 hilus. The percentage of right accessory renal arteries is almost twice that of the left and more than twice the bilateral accessory arteries. Accessory renal artery is a common but a significant anatomical variant of the renal vascular system, due to their clinical importance. In our sample, the accessory renal artery presence was detected in 6% and displayed a greater variation on the right than the left side. Because this abnormality plays an important role in kidney transplantations, in radiological, vascular and urological interventions, a detailed presentation of accessory renal artery incidence was conducted, gathering from the literature a large number of relevant studies in order to create a classification according to population, gender, side and specimen. The study concluded that the renal arteries present a broad spectrum of variability in their morphological expression regarding their length, diameter and entrance to the kidney parenchyma, additional arteries’ morphological expression was higher in men than women. This is statistically not significant and variation in the right side was found greater frequency than the left side.

Infective Artery Rupture of Renal Allografts:A Single-Center Retrospective Study in China

Objective:This study investigated the composition of pathogenic microorganisms,clinical features,and therapeutic strategies of infective artery rupture of renal allografts in recipients receiving deceased donor(DD)kidneys.Methods:We retrospectively studied the clinical data of the DD kidney transplant recipients with donor-associated infection at Tongji Hospital,Wuhan,China from January 1,2015 to December 31,2018,related recipients and corresponding donors.We collected the entire results of pathogenic microorganisms cultured from these related ruptured kidneys and then analyzed their distribution and differences.Results:A total of 1440 kidney transplants from DD were performed in our center.The total incidence of infective artery rupture in kidney transplants was about 0.76%(11/1440),and the annual incidence ranged from 0.25%to 1.03%.The microbial culture results revealed that 11 recipients suffered from infective artery rupture and 3 recipients who accepted the kidney from same donor had the donor-associated pathogens,including 9 fungal strains(28.1%)and 23 bacterial strains(71.9%).There were 4 recipients infected with multi-drug-resistant Staphylococcus and Klebsiella pneumoniae from the above 11 recipients,of which,10 recipients underwent graft loss,and one died of septic shock.The microbial cultures of the remaining 3 recipients who received appropriate anti-infective regimens turned negative eventually,and the patients were discharged successfully without significant complications.Conclusion:Renal recipients with infections derived from DDs were at high risk of artery rupture,graft loss,or even death.Appropriate anti-infective treatment is essential to reduce the incidence of artery rupture and mortality.

Efficacy and safety of a novel multi-electrode radiofrequency ablation catheter for renal sympathetic denervation in pigs

Objective To investigate the safety and efficacy of a self-developed novel multi-electrode radiofrequency ablation catheter （Spark） for catheter-based renal denervation （RDN）. Methods A total of 14 experimental miniature pigs were randomly divided into four groups （55°＆ 5-watt, 55°＆ 8-watt, 65°＆ 5-watt, and 65° ＆ 8-watt groups）. Spark was used for left and right renal artery radiofrequency ablation. Blood samples collected from renal arteries and veins as well as renal arteriography were performed on all animals before, immediately after, and three months after procedure to evaluate the effects of Spark on the levels of plasma renin, aldosterone, angiotensin I, and angiotensin II as well as the pathological changes of renal arteries. Results One pig died of an anesthetic accident, 13 pigs successfully underwent the bilateral renal artery ablation. Compared with basic measurements, pigs in all the four groups had significantly decreased mean arterial pres- sure after procedure. Histopathological analysis showed that this procedure could result in intimal hyperplasia, significant peripheral sympa- thetic nerve damage in the renal arteries such as inflammatory cell infiltration and fibrosis in perineurium, uneven distribution of nerve fibers, tissue necrosis, severe vacuolization, fTagmented and unclear nucleoli myelin degeneration, sparse axons, and interruption of continuity. In addition, the renal artery radiofrequency ablation could significantly reduce the levels of plasma renin, aldosterone, angiotensin I, and angio- tensin II in pigs. Conclusions The results suggest that this type of multi-electrode catheter-based radiofrequency ablation could effectively remove peripheral renal sympathetic nerves and reduce the activity of systemic renin-angiotensin system in pigs, thus facilitating the control of systemic blood pressure in pigs.

Renal artery embolization in the treatment of urinary fistula after renal duplication:A case report and review of literature

BACKGROUND Duplicate renal malformation is a congenital disease of the urinary system,with an incidence rate of 0.8%.Surgical treatment is suitable for symptomatic patients.Urinary fistula is one of the complications of heminephrectomy.Long-term urinary fistula has a great impact on patients'lives.CASE SUMMARY This article mainly reports on a 47-year-old man with duplication of kidney deformity,long urinary fistula after partial nephrectomy,and no improvement after conservative treatment.We have achieved positive results in the arterial embolization treatment of the residual renal artery,indicating that selective arterial embolization is a good way to treat urinary fistula after partial nephrectomy.It is worth noting that this patient violated the Weigert-Meyer law,which also gave us more consideration.CONCLUSION Renal artery embolization may be a simple and safe method to treat urinary fistula inefficacy with conservative treatment.

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

Background:To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization(SRAE)with N-butyl cyanoacrylate(NBCA)for iatrogenic renal hemorrhage.Methods:Between January 2014 and December 2019,45 patients(including 18 patients with coagulopathy),who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution,were retrospectively reviewed.The technical success rate,clinical success rate,and embolization-related complications were analyzed.The values of estimated glomerular filtration rate(eGFR),serum creatinine(sCr),and serum urea(sUr)were analyzed at the time of pre-SRAE,post-SRAE,and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.Results:Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients.NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent.No procedure-related mortality or major complications occurred.The technical and clinical success rates were both 100%.The values of eGFR,sCr and sUr were not found to be significantly different between pre-SRAE,post-SRAE and last follow-up(eGFR:91.52±21.17 vs.90.98±22.11 vs.92.14±23.51 mL/min/1.73 m^(2),p=0.729;sCr:74.73±11.08 vs.75.27±12.43 vs.73.95±10.14μmol/L,p=0.543;sUr:5.69±0.84 vs.5.71±0.96 vs.5.70±0.79,p=0.515,respectively).Conclusions:Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

Safety and efficacy of Endovascular Management of high-grade blunt renal injury

Objectives:To provide data on the safety and efficacy of renal arterial embolization(RAE)in patients with highgrade blunt renal injury.Materials and methods:Fifteen patients with high-grade blunt renal injury(AAST grades IV-V)admitted to our hospital from July 2014 to December 2019 were retrospectively reviewed in this study.Their clinical success rate and complications were investigated accordingly.Results:Fifteen patients with high-grade blunt renal injury,13 men and 2 women with an average age of 41.6 years,including 11 hemodynamically unstable patients and 4 stable patients,were treated with RAE.Among these patients,73.3%(11 of 15)had grade IV,and 26.7%(4 of 15)had grade V injuries,while 53.3%(8 of 15)patients had concomitant injuries.One patient received main RAE and 14 patients received selective RAE.The clinical success rate after the first embolization was 93.3%(14 of 15).RAE was repeated and was successfully performed in one patient with sustained hematuria.No significant difference in creatinine levels was found before and after embolization.During the follow-up period of 2–82 months,two patients required tube drainage due to urine leaks,one patient developed renal failure requiring renal replacement therapy,and one patient developed secondary hypertension.Conclusions:RAE can provide a high success rate of hemostasis for both hemodynamically stable and unstable patients with high-grade blunt renal injury,and only minor complications are observed with this procedure.

A Clinical Investigation on 30 Cases of Senile Benign Renal Arteriolosclerosis Treated by Huang Qi Gu Jing Yin

Huang Qi Gu Jing Yin (HQGJY[symbol: see text]decoction of Astragalus root for Strengthening the Essence) was used in a controlled clinical trial for treatment of senile benign renal arteriolosclerosis. In the therapeutic group (n = 30), cure, marked effect and no effect were obtained respectively in 18 (60%), 9 (30%) and 3 (10%) cases with the total effective rate being 90%; the corresponding figures in the control group (n = 30) were 10 (33.3%), 9 (30%) and 11 (36.7%) with the total effective rate being 63.3%. The significant difference (P

Retrieval of dislodged coronary stent from left renal artery by gooseneck snare

A rapamycin-eluting stent was dislodged during attempt of implantation at the proximal right coronary artery,which was found by fluoroscopy to have migrated into the anterior trunk of the left renal artery.We chose a 5 mm diameter Amplatz gooseneck snare and successfully retrieved the lost stent from the lodging vessel.

Preliminary Evaluation of Hemodynamic Effects of Fontan Palliation on Renal Artery Using Computational Fluid Dynamics

Background:The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation.To know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury(AKI)and the postoperative complications.However,the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery(RA).Methods:We reconstructed a three-dimensional(3D)vascular model of a patient requiring Fontan palliation.The technique of computational fluid dynamics(CFD)was utilized to explore the changes of RA hemodynamics under different possible blood flow rates.The relationship between the kidney perfusion and hemodynamic characteristics was investigated.Results:The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate decreased.When the flow rate decreased to two-thirds of its baseline,both the pressure of left renal artery(LRA)and the pressure of right renal artery(RRA)dipped below 50%,and the pressure of RRA fell more quickly than that of LRA.Uneven distribution of WSS was observed on the trunk of RA,and the lowest WSS was found at the distal of RA.The average WSS in RA dropped to around 50%as the flow rate reached one-third of its baseline.Conclusions:As a promising approach,CFD can be utilized to quantitatively evaluate the hemodynamic characteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function,to help realize better prognosis for the patients with Fontan palliation.

Rotarex mechanical thrombectomy in renal artery thrombosis:A case report

BACKGROUND Acute renal artery thrombosis is a relatively rare disease.Early diagnosis and emergent treatment can prevent the loss of renal function and the development of hypertension.CASE SUMMARY We report a patient with acute renal artery thrombosis who presented to our hospital with acute-onset right flank pain and was treated by percutaneous mechanical thrombectomy using the Rotarex device.After 2 mo,right kidney function had recovered slightly.CONCLUSION Renal artery thrombosis may lead to loss of renal function and the development of hypertension.Rotarex mechanical thrombectomy may be a viable treatment option for rapid recanalization of the renal artery in patients with renal artery thrombosis.

Prognostic indicator by urinary microglobulin after renal stenting

Objective To evaluate the effect of revascularization of the renal artery on urinary microglobulin in patients with coronaryartery disease and significant renal artery stenosis(RAS).Methods Forty-four patients with coronary artery disease and severe RAS(luminal narrowing>70%)underwent percutaneous transluminal renal artery angioplasty(PTRA)and stenting,as well as percutaneous coronary intervention.The urine-microglobulin(α_(1)-MG)andβ_(2)-Cmicroglobulin(β_(2)-MG)at baseline and at 3 months after the procedures were measured.Procedural success rate,procedural complications,serum creatinine concentration at baseline and at 3-months were also recorded.Results At 3-months after the renal revascularization therapy,there was no significant change of urineα_(1)-MG ompared with that of the baseline,however,the urineβ_(2)-MG decreased significantly 3-months after the treatment(237±187μg/L vs 377±173μg/L,P<0.01).Multivariate analysis revealed that persistent elevation of urine was an independent predictor of severe events(including re-admission and renal failure)after renal revascularization therapy in patients with severe RAS(OR=3.01,95%CI 1.01-8.95,P=0.036).Conclusions In patients with coronary artery disease and severe RAS,revascularization with PTRA and stenting may improve renal tubular function,but a continuous high level of urinary microglobulins after intervention is associated with more frequent re-hospitalization and renal failure.