HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Morris, C. S. Articles by Najarian, K. E. Search for Related Content PubMed PubMed Citation Articles by Morris, C. S. Articles by Najarian, K. E. Social Bookmarking                      What's this?

Nonsurgical Treatment of Acute Iatrogenic Renal Artery Injuries Occurring After Renal Artery Angioplasty and Stenting

¹ Department of Radiology, Patrick 1, Fletcher Allen Health Care, University of Vermont College of Medicine, 111 Colchester Ave., Burlington, VT 05401.

View larger version (119K): [in a new window]   Fig. 1A. —64-year-old woman with acute renal artery rupture that occurred after renal artery dilatation with 6-mm stent. She had initially presented with uncontrolled hypertension and congestive heart failure and had been treated with bilateral renal artery angioplasty and stenting for bilateral renal artery stenoses. Renal flush aortogram obtained after left renal artery stenting shows extravasation (arrow) from main left renal artery, located at distal end of stent.

View larger version (120K): [in a new window]   Fig. 1B. —64-year-old woman with acute renal artery rupture that occurred after renal artery dilatation with 6-mm stent. She had initially presented with uncontrolled hypertension and congestive heart failure and had been treated with bilateral renal artery angioplasty and stenting for bilateral renal artery stenoses. Aortogram with 5-mm balloon inflated in left main renal artery to tamponade ruptured renal artery shows no flow into renal artery.

View larger version (107K): [in a new window]   Fig. 1C. —64-year-old woman with acute renal artery rupture that occurred after renal artery dilatation with 6-mm stent. She had initially presented with uncontrolled hypertension and congestive heart failure and had been treated with bilateral renal artery angioplasty and stenting for bilateral renal artery stenoses. Selective left renal artery angiogram obtained after balloon tamponade shows no sign of continued extravasation.

View larger version (115K): [in a new window]   Fig. 2A. —45-year-old woman with renal artery dissection causing acute thrombotic occlusion after 5-mm balloon angioplasty of distal main renal artery and placement of 6-mm stent in proximal renal artery. Patient initially had presented with malignant hypertension and fibromuscular dysplasia of both renal arteries that had been treated with bilateral renal artery angioplasty and stenting of the proximal right renal artery. Aortogram obtained after right renal artery angioplasty and stenting reveals widely patent right renal artery with no evidence of dissection flap. Guidewire-induced vasospasm of several intrarenal branch arteries is visualized.

View larger version (102K): [in a new window]   Fig. 2B. —45-year-old woman with renal artery dissection causing acute thrombotic occlusion after 5-mm balloon angioplasty of distal main renal artery and placement of 6-mm stent in proximal renal artery. Patient initially had presented with malignant hypertension and fibromuscular dysplasia of both renal arteries that had been treated with bilateral renal artery angioplasty and stenting of the proximal right renal artery. Carbon dioxide aortogram obtained 24 hr later shows occlusion (arrow) of right renal artery and stent overlying patent superior mesenteric artery.

View larger version (137K): [in a new window]   Fig. 2C. —45-year-old woman with renal artery dissection causing acute thrombotic occlusion after 5-mm balloon angioplasty of distal main renal artery and placement of 6-mm stent in proximal renal artery. Patient initially had presented with malignant hypertension and fibromuscular dysplasia of both renal arteries that had been treated with bilateral renal artery angioplasty and stenting of the proximal right renal artery. Selective right renal artery angiogram obtained immediately after thrombolysis reveals small intimal dissection flap (straight arrow) and residual nonocclusive intraluminal thrombus (curved arrow).

View larger version (105K): [in a new window]   Fig. 2D. —45-year-old woman with renal artery dissection causing acute thrombotic occlusion after 5-mm balloon angioplasty of distal main renal artery and placement of 6-mm stent in proximal renal artery. Patient initially had presented with malignant hypertension and fibromuscular dysplasia of both renal arteries that had been treated with bilateral renal artery angioplasty and stenting of the proximal right renal artery. Final postthrombolysis and adjunctive stent dilatation aortogram shows widely patent right renal artery. Originally placed proximal Palmaz stent (Johnson & Johnson, Warren, NJ; straight arrow) and newly placed 6-mm Wallstent (Schneider, Minneapolis, MN; curved arrows) overlap each other.

View larger version (130K): [in a new window]   Fig. 3A. —65-year-old woman with probable guidewire perforation, causing a large perirenal and pararenal hematoma. Patient had initially presented with hypertension, renal insufficiency, and bilateral renal artery stenoses and had undergone bilateral angioplasty and stenting. Aortogram obtained after left renal artery stenting shows looped configuration of distal guidewire tip (arrow) that does not conform to vessel lumen.

View larger version (130K): [in a new window]   Fig. 3B. —65-year-old woman with probable guidewire perforation, causing a large perirenal and pararenal hematoma. Patient had initially presented with hypertension, renal insufficiency, and bilateral renal artery stenoses and had undergone bilateral angioplasty and stenting. Abdominal CT scan obtained immediately after procedure shows large left-sided perirenal and pararenal hematoma (arrows) displacing left kidney.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati