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.

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.

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.

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.

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.

Main Renal Artery Plus Branch Ablation in the Treatment of Resistant Hypertension with Renal Denervation

Objective:To study the safety and effi cacy of denervation of renal artery branches in the treatment of resistant hy-pertension.Methods:Sixty patients with resistant hypertension were enrolled.The patients were randomly assigned to the main renal artery plus branch ablation group or the main renal artery ablation group.The clinical data and operation-related parameters,including number of ablation points,temperature,and average energy,were recorded.Ambulatory blood pressure was taken for all patients at the baseline and at 6 months after treatment.Offi ce blood pressure was recorded before treatment and after treatment every 3 months for 2 years.Results:Sixty patients with resistant hypertension were enrolled in this study.There were 30 patients in each group.Angiography was performed after ablation.No renal artery complications,such as stenosis and dissection,occurred in the two groups.There was no signifi cant difference in age,sex,BMI,comorbid disease,and medication between the two groups(P>0.05).The number of ablation points for the main renal artery plus branch ablation group was greater than that for the main renal artery ablation group.The offi ce blood pressure and 24-hour blood pressure were signifi cantly lower 6 months after treatment than before treatment in both groups(P<0.05).Offi ce blood pressure in the main renal artery plus branch ablation group was lower than that in the main renal artery ablation group during the 3-12-month follow-up period,with a statistical difference.However,as the follow-up time increased,the difference disappeared.Conclusion:The results of this study show that main renal artery plus branch ablation is a safe interventional method,but there was no obvious advantage on long-term follow-up compared with only main renal artery ablation.

Renal function after renal artery stenting

Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ～ 7% of persons over 65 years of age1 and in ～ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.

Common trunk of the right accessory renal artery and right inferior phrenic artery originating from the thoracic artery:An unreported variation

Accessory renal arteries(ARAs)are common and usually originate from the abdominal aorta and the renal artery.Inferior phrenic arteries(IPAs)can also arise from the abdominal aorta or its branches.In this paper,we present the first case of a common trunk of the right ARA and right IPA arising from the thoracic artery at the level of T10,which was discovered by multidetector-row computed tomography in pretherapeutic evaluation and clearly confirmed by selective angiography.It is important to recognize this anatomical variation when performing cardiovascular and interventional radiological procedures.

Acute renal artery occlusion following infliximab infusion

We report the case of a 44-year-old male patient who presented with acute renal artery occlusion, 3 d after frst injection of infiximab for steroid refractory attack of ulcerative colitis. Extensive work-up provided no evidence of predisposing factors for arterial thrombosis. Infiximab was thus suspected in the genesis of throm-bosis, based on both intrinsic and extrinsic criteria. At month 3 after thrombosis with ongoing anticoagulation, angio-tomodensitometry showed complete revascularization of the left renal artery with renal atrophy. Renal function remained normal and the patient was still in steroid free remission on mercaptopurin monotherapy at maximal follow-up. Few thromboembolic events have been described with anti- tumor necrosis factor （TNF） agents, but it is the frst case reported of renal artery thrombosis after infiximab infusion. In addition, we re-view thrombosis associated with anti-TNF agents.

Enlarged and Colored Enhanced 3D Printing of Renal Artery Aneurysms for Improved Imaging and Treatment Planning

Three dimensional printing (3D printing) technology is increasingly used to improve results in many areas of medicine. Physical models produced by this technology allow better appreciation of complex anatomical and pathologic conditions. In cardiovascular medicine and surgery, 3D modeling has been reported to be of help in treatment planning of abdominal aortic aneurysm, especially in cases of complex angulations and branching at the aneurysm neck. Here we report the use of 3D printing in cases of renal aneurysms. Enhanced 3D models of CTA images of renal aneurysms were prepared in house using common and freely available software programs, and an accurate desktop 3D printer. Eight reconstructed models were enlarged by a factor of 2 or more and then differentially painted to delineate normal arteries and aneurysmatic ones. These enhanced 3D solid models allowed visual and tactile inspection for a better appreciation of complex aneurysms. Color enhancement of these models added another dimension of comprehension, even for experienced surgeons and invasive radiologists, and allowed more accurate measurements of branch numbers, distances, and angles in space even with severe tortuosity. Endovascular use of covered stents and embolization techniques could be easily envisioned preoperatively. We conclude that enhanced, enlarged, and colored 3D printed models are a powerful tool for preoperative endovascular treatment planning of complex renal artery aneurysms.

Risk factors of renal artery pseudoaneurysm following partial nephrectomy

Objective To study the risk factors of renal artery pseudoaneurysm ( RAP) following partial nephrectomy. Methods Open partial nephrectomhy was performed on a total of 464 cases of renal cell cancer from July 2003 to May 2010. Five patients ( 1. 1% ) had postoperative hem-

Endovascular treatment of traumatic renal artery pseudoaneurysm with a Stanford type A intramural haematoma:A case report

BACKGROUND Aortic intramural hematoma(IMH) associated with aortic branch tear and intramurally located pseudoaneurysm after blunt trauma has not been reported.Here,we report a case of progressive type A aortic IMH associated with a pseudoaneurysm arising from the injured proximal renal artery after blunt trauma.CASE SUMMARY During logging operations,a 66-year-old man experienced blunt force trauma after being injured by a fallen tree.He arrived at our trauma center with a left flank pain complaint.Computed tomography(CT) revealed a pseudoaneurysm arising from the proximal renal artery(localized within the aortic media) and Stanford type A IMH.A covered stent was deployed along the left main renal artery,bridging the pseudoaneurysm and covering the parent artery,successfully excluding the pseudoaneurysm as confirmed using aortography.However,although the degree of the pseudoaneurysm decreased,follow-up CT revealed remnant pseudoaneurysm,likely caused by an endoleak.Subsequently,a covered stent was additionally installed through the previously deployed covered stent.Successful exclusion of the pseudoaneurysm was confirmed using final aortography.In the 7-mo follow-up CT scan,the IMH and pseudoaneurysm completely disappeared with no evidence of stent-related complications.CONCLUSION Endovascular treatment such as stent-graft placement can be an effective and safe treatment for traumatic renal artery injury.

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.

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.

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.

Efficacy and safety of low-dose aspirin on preventing transplant renal artery stenosis: a prospective randomized controlled trial

Background:Transplant renal artery stenosis(TRAS)is a vascular complication after kidney transplantation associated with poor outcomes.This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods:After kidney transplantation,patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital.A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment(n=178),or a control group with only standard treatment(n=173).The patients was initially diagnosed as TRAS(id-TRAS)by Doppler ultrasound,and confirmed cases were diagnosed by DSA(c-TRAS).Results:In the aspirin and control groups,15.7%(28/178)and 22.0%(38/173)of the recipients developed id-TRAS,respectively,with no statistical difference.However,for c-TRAS,the difference of incidence and cumulative incidence was statistically significant.The incidence of c-TRAS was lower in the aspirin group compared with the control group(2.8%[5/178]vs.11.6%[20/173],P=0.001).Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio(HR)of TRAS over time in two groups,showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated(log-rank P=0.001,HR=0.23,95%confidence interval[CI]:0.09–0.62).The levels of platelet aggregation rate(P<0.001),cholesterol(P=0.028),and low-density lipoprotein cholesterol(P=0.003)in the aspirin group were decreased compared with the control group in the third-month post-transplantation.For the incidence of adverse events,there was no statistical difference.Conclusion:Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration:Clinicaltrials.gov,NCT04260828.

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.

Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis

Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.

Kidney salvage by catheter guided thrombolysis in acute renal artery thromboembolic occlusions

Acute renal artery occlusion （ARAO） is a rare clinical entity. Typical clinical presentations of ARAO are non-specific and include acute lumbar or abdominal pain coexisting with nausea, vomiting and fever. Peripheral emboli are the major cause of ARAO, predominantly arising from cardiac diseases. Other, relatively frequent causes of ARAO include atherosclerosis, trauma, dissection or renal artery aneurysms.

Analysis of Renal Artery Stenosis in Patients with Heart Failure： A RASHEF Study

Background： Previous data are controversial about the association of renal artery stenosis （RAS） with clinical outcome in patients with heart failure. Definition of RAS in previous studies might not be appropriate. By definition of RAS with renal duplex sonography, we investigated the association of RAS with clinical outcome in patients with heart failure. Methods： In this retrospective study, we identified 164 patients with heart failure （New York Heart Association classification ≥11; left ventricular ejection fraction 〈50%） who had received renal duplex sonography during hospital stay. RAS was defined as renal-aortic ratio 〉3.5 or a peak systolic velocity ≥200 cm/s （or both）, or occlusion of the renal artery. Categorical data of patients were compared using the Chi-square test or Fisher＇s exact test. Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors. Results： Finally, 143 patients were enrolled, Median follow-up time was 32 months （1-53 months）. Twenty-two patients were diagnosed as RAS by renal duplex sonography, including 13 unilateral RAS （3 left RAS, l0 right RAS） and 9 bilateral RAS. There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS. By multivariate analysis, RAS was a significant predictor for all-cause death and cardiovascular death （hazard ratio [HR] = 4.155, 95% confidence interval [（7/]： 1.546-1 1. 164, P = 0.005; and MR = 3.483, 95% CI： 1.200-10.104, P = 0.022, respectively）. As for composite endpoint events, including death, nonfatal myocardial infarction, ischemic stroke or intracranial hemorrhage, rehospitalization for cardiac failure, and renal replacement therapy, only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor. RAS was not a significant predictor for composite endpoint events. Conclusions： Our data suggested that RAS is associated with a poorer clinical outcome in patients with heart failure.