Antiphospholipid syndrome with renal and splenic infarction after blunt trauma:A case report

BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.

Clinical features of renal artery stenosis in elderly patients

Together with an increasingly aging world population there is also an increasing prevalence of atherosclerosis. Renal artery stenosis （RAS） is one of the systemic manifestations of atherosclerosis. Its incidence is about 15%-35%. RAS accounts for 5%-27% of all patients with end-stage renal disease （ESRD）. Patients with renal dysfunction resulting from RAS are at risk of death from cardiovascular disease and ESRD.

Association of atherosclerotic renal artery stenosis with major adverse cardiovascular events after acute myocardial infarction

Background Patients with atherosclerotic renal artery stenosis （ARAS） are in substantial risk of cardiovascular adverse events.We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events.Methods In this retrospective study,257 patients with type 1 myocardial infarction were enrolled.Median follow-up was 42 months.Composite endpoint events are analyzed by definitions of ARAS as ≥50% or ≥70% diameter stenosis.Results Defining ARAS as ≥70% diameter stenosis,ARAS was a significant predictor for composite endpoint events including death,non-fatal myocardial infarction,ischaemic stroke and intracranial haemorrhage,rehospitalisation for cardiac failure （HR：4.381; 95% Cl：1.770-10.842） by Cox regression analysis,but not for death.Diabetes mellitus was also a significant predictor for composite endpoint events （HR：2.756; 95% Cl：1.295-5.863）.However,defining ARAS ≥50% diameter stenosis,ARAS was no longer a significant predictor for composite endpoint events or death.Conclusions Although not associated with mortality,ARAS ≥70% is associated with major adverse cardiac events after acute myocardial infarction.For prognosis,≥70% diameter stenosis is a more appropriate criteria for ARAS definition than ≥50% diameter stenosis.

Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model

Background： Accumulating studies on computational fluid dynamics （CFD） support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis （TRAS） and its alteration after stent treatment. Methods： Computed tomography angiography （CTA） data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery （TRA） was reconstructed from the qualified CTA images and categorized into three groups： the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress （WSS）, and mass flow rate （MFR） were extracted. The data of hemodynamic parameters were expressed as median （interquartile range）, and Mann-Whitney U-test was used for analysis. Results： Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS （2.94 [2.14, 3.30] vs. 1.06 /0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P - 0.001 ; 3.25 [2.67, 3.56] vs. 1.65 [ 1.18, 1.72] m/s, 281.3 [ 184.3,364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P - 0.001 ） and lower minimal WSS and MFRs （0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P = 0.001 ; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P 0.001） as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Conclusions： Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or ameliorate deleterious change of hemodynamic factors except low WSS at stent regions.

Follow-up of combined intervention for patients with both renal and cerebral artery stenosis

Renal artery stenosis （RAS） is a frequently overlooked clinical entity that can cause uncontrolled hypertension and lead to a progressive deterioration of renal function.1 We observed 20 patients with RAS complicated with cerebral artery stenosis （CAS）, who underwent cerebral and renal artery angiography and combined intervening treatment. Clinical follow-up was performed for more than 3 years.