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 insert...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.展开更多
Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a ca...Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a case of early TRAS detected 6 hours after a successful renal transplant. Renal angiography showed complete stenosis of the internal iliac to renal artery anastomosis. Percutaneous transplant artery angioplasty was attempted, but was not successful;hence the surgical correction of the same was done. This is to demonstrate the use of saphenous vein bypass of anastomotic obstruction of the previous anastomosis, in case of short renal artery.展开更多
Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated...Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.展开更多
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 ...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.展开更多
Background Balanced steady-state free precession MR angiography （b-SSFP MRA） has shown great promise in diagnosing renal artery stenosis （RAS） as a non-contrast MR angiography （NC-MRA） method. However, results f...Background Balanced steady-state free precession MR angiography （b-SSFP MRA） has shown great promise in diagnosing renal artery stenosis （RAS） as a non-contrast MR angiography （NC-MRA） method. However, results from related studies are inconsistent. The purpose of this meta-analysis was to assess the accuracy of b-SSFP MIRA compared to contrast-enhanced MR angiography （CE-MRA） in diagnosing RAS. Methods English and Chinese studies that were published prior to September 4, 2013 and that assessed b-SSFP MRA diagnostic performance in RAS patients were reviewed. Quality of the literature was assessed independently by two observers. The statistical analysis was adopted by the software of Meta-Disc version 1.4. Using the heterogeneity test, a statistical effect model was chosen to calculate different pooled weighted values. The receiver operator characteristic （ROC） space and Spearman correlation coefficient were to explore threshold effect. Sensitivity analysis and the publication bias were performed to demonstrate if the pooled estimates were stable and reliable. We produced forest plots to calculate the pooled values and corresponding 95% confidence interval （Cl） of sensitivity, specificity, positive likelihood ratio （PLR）, negative likelihood ratio （NLR）, diagnostic odds ratio （DOR）, and constructed a summary receiver operating characteristic curve （SROC） to calculate the area under the curve （AUC）. Results A total of 10 high quality articles were used in this meta-analysis. The studies showed a high degree of heterogeneity. The ＂shoulder-arm＂ shape in the ROC plot and the Spearman correlation coefficient between the log（SEN） and Iog（1-SPE） suggested that there was a threshold effect. Sensitivity analysis demonstrated that the actual combined effect size was equal to the theoretical combined effect size. The publication bias was low after quality evaluation of the literature and the construction of a funnel plot. The pooled sensitivity was 0.88 （95% CI, 0.83-0.91） and pooled specificity was 0.94 （95% CI, 0.93-0.95）; pooled PLR was 14.57 （95% CI, 9.78-21.71]） and pooled NLR was 0.15 （95% CI, 0.11- 0.20）. The AUC was 0.964 3. Conclusion In contrast to CE-MRA, the b-SSFP MIRA is more accurate in diagnosing RAS, and may be able to replace other diagnostic methods in patients with renal insufficiency.展开更多
文摘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.
文摘Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a case of early TRAS detected 6 hours after a successful renal transplant. Renal angiography showed complete stenosis of the internal iliac to renal artery anastomosis. Percutaneous transplant artery angioplasty was attempted, but was not successful;hence the surgical correction of the same was done. This is to demonstrate the use of saphenous vein bypass of anastomotic obstruction of the previous anastomosis, in case of short renal artery.
文摘Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.
基金This study was supported by a grant from the National Natural Science Foundation of China （No.30725034）.
文摘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.
文摘Background Balanced steady-state free precession MR angiography （b-SSFP MRA） has shown great promise in diagnosing renal artery stenosis （RAS） as a non-contrast MR angiography （NC-MRA） method. However, results from related studies are inconsistent. The purpose of this meta-analysis was to assess the accuracy of b-SSFP MIRA compared to contrast-enhanced MR angiography （CE-MRA） in diagnosing RAS. Methods English and Chinese studies that were published prior to September 4, 2013 and that assessed b-SSFP MRA diagnostic performance in RAS patients were reviewed. Quality of the literature was assessed independently by two observers. The statistical analysis was adopted by the software of Meta-Disc version 1.4. Using the heterogeneity test, a statistical effect model was chosen to calculate different pooled weighted values. The receiver operator characteristic （ROC） space and Spearman correlation coefficient were to explore threshold effect. Sensitivity analysis and the publication bias were performed to demonstrate if the pooled estimates were stable and reliable. We produced forest plots to calculate the pooled values and corresponding 95% confidence interval （Cl） of sensitivity, specificity, positive likelihood ratio （PLR）, negative likelihood ratio （NLR）, diagnostic odds ratio （DOR）, and constructed a summary receiver operating characteristic curve （SROC） to calculate the area under the curve （AUC）. Results A total of 10 high quality articles were used in this meta-analysis. The studies showed a high degree of heterogeneity. The ＂shoulder-arm＂ shape in the ROC plot and the Spearman correlation coefficient between the log（SEN） and Iog（1-SPE） suggested that there was a threshold effect. Sensitivity analysis demonstrated that the actual combined effect size was equal to the theoretical combined effect size. The publication bias was low after quality evaluation of the literature and the construction of a funnel plot. The pooled sensitivity was 0.88 （95% CI, 0.83-0.91） and pooled specificity was 0.94 （95% CI, 0.93-0.95）; pooled PLR was 14.57 （95% CI, 9.78-21.71]） and pooled NLR was 0.15 （95% CI, 0.11- 0.20）. The AUC was 0.964 3. Conclusion In contrast to CE-MRA, the b-SSFP MIRA is more accurate in diagnosing RAS, and may be able to replace other diagnostic methods in patients with renal insufficiency.
