Acute Renal Artery Occlusion

Lohse, James R.; Shore, Richard M.; Belzer, Folkert O.

doi:10.1001/archsurg.1982.01380300043010

Cited by 33 publications

(6 citation statements)

References 9 publications

(1 reference statement)

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“…This is the case for the coronary setting 6,7 but also holds true for other organs, such as the brain 24,25 and kidney. 26,27 It is thus of utmost importance to unravel the determinants of sufficient collateral artery growth. Native collateral vessels are already formed during the fetal stage of life 28 and remain present, at least in part, throughout life.…”

Section: Discussionmentioning

confidence: 99%

Coronary Collateral Flow Index Is Correlated With the Palmar Collateral Flow Index

Hollander

Jansen

Schumacher

et al. 2021

ATVB

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Objective: The extent of the collateral circulation varies between individuals which affects morbidity and mortality. Experimental data show that collateral coherence between different organs is strain-dependent. Whether this interrelation is also present in humans is unknown. This study investigates the relation between the palmar and the coronary circulation in patients with coronary artery disease and which factors possibly influence collateral development. Approach and Results: In 50 patients with a chronic total occlusion, both the coronary collateral flow index (CFI) and the palmar CFI was measured. The correlation between both indices was determined, together with the relation to clinical variables. Mean coronary CFI was 0.51±0.16, and mean palmar CFI was 0.82±0.13. The coronary and palmar CFI were significantly correlated (ρ=0.48, P =0.001). Coronary CFI was 22% lower in low palmar CFI patients (<0.82) as compared with high palmar CFI patients (0.43±0.12 versus 0.57±0.18, P =0.03). In multivariable analysis, coronary CFI was significantly correlated with the palmar CFI and the duration of angina pectoris. Coronary CFI was inversely correlated with peripheral artery disease and systolic blood pressure. Conclusions: The coronary CFI and palmar CFI are significantly correlated, implicating collateral coherence between vascular beds in humans.

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Section: Discussionmentioning

confidence: 99%

Coronary Collateral Flow Index Is Correlated With the Palmar Collateral Flow Index

Hollander

Jansen

Schumacher

et al. 2021

ATVB

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“…In our patient, the disease process involved an occluded vessel extending into the lower pole of the right kidney. Interestingly, this lower pole was instead supplied by collateral vessels from the right adrenal artery, an adaptation described in humans and animal models in response to renal artery occlusion ( 3 ). In contrast to other organs such as the heart, the effectiveness of collateral vessels in preserving kidney function remains controversial and depends largely on the degree of the stenotic vessel ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, this lower pole was instead supplied by collateral vessels from the right adrenal artery, an adaptation described in humans and animal models in response to renal artery occlusion ( 3 ). In contrast to other organs such as the heart, the effectiveness of collateral vessels in preserving kidney function remains controversial and depends largely on the degree of the stenotic vessel ( 3 ). In our report, these collateral vessels failed to supply the lower pole of the right kidney adequately and alleviate ischemia, thus stimulating activation of the renin-angiotensin system, as evident by increasing levels of renin and aldosterone.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Resistant Hypertension Secondary to Fibromuscular Dysplasia

et al. 2020

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A 28-year-old woman with resistant hypertension was given a diagnosis of fibromuscular dysplasia with 100% occlusion of a right renal artery branch supplying an atrophied lower pole, collateralized by the right adrenal artery. Successful adrenal collateral coil embolization restored normotension, but hypertension recurred, necessitating right partial heminephrectomy with blood pressure normalization off medications. ( Level of Difficulty: Intermediate. )

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“…Although current understanding is primarily derived from studies of other vascular beds, evidence obtained in both animals and humans supports a similar pattern of rapid and meaningful proliferation of collateral arteries in the kidney following renovascular arterial obstruction. 16,20,28,45–47 These processes may lead to development and expansion of several higher-caliber renal collaterals. Most likely, a mature renal collateral circulation with larger and smaller (perhaps radiographically invisible) collaterals develop due to what, according to Poiseuille law, is a more energy-efficient remodeling, as some collaterals become dominant while others regress (Figure 2).…”

Section: Collateral Formation In Arvdmentioning

confidence: 99%

With a Little Help From My Friends: the Role of the Renal Collateral Circulation in Atherosclerotic Renovascular Disease

Nyvad

Lerman

2022

Hypertension

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The collateral circulation can adapt to bypass major arteries with limited flow and serves a crucial protective role in coronary, cerebral, and peripheral arterial disease. Emerging evidence indicates that the renal collateral circulation can similarly adapt and thereby limit kidney ischemia in atherosclerotic renovascular disease. These adaptations predominantly include recruitment of preexisting microvessels for arteriogenesis, with de novo vessel formation playing a limited role. Yet, adaptations of the renal collateral circulation in renovascular disease are often insufficient to fully compensate for the limited flow within an obstructed renal artery and may be hampered by the severity of obstruction or patient comorbidities. Experimental strategies have attempted to circumvent limitations of collateral formation and improve the prognosis of patients with various ischemic vascular territories. These have included pharmacological approaches such as endothelial growth factors, renin-angiotensin-aldosterone system blockade, and If-channel-blockers, as well as interventions like preconditioning, exercise, enhanced external counter-pulsation, and low-energy shock-wave therapy. However, few of these strategies have been implemented in atherosclerotic renovascular disease. This review summarizes current understanding regarding the development of renal collateral circulation in atherosclerotic renovascular disease. Studies are needed to apply lessons learned in other vascular beds in the setting of atherosclerotic renovascular disease to develop new treatment regimens for this patient group.

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Acute Renal Artery Occlusion

Cited by 33 publications

References 9 publications

Coronary Collateral Flow Index Is Correlated With the Palmar Collateral Flow Index

Coronary Collateral Flow Index Is Correlated With the Palmar Collateral Flow Index

An Unusual Case of Resistant Hypertension Secondary to Fibromuscular Dysplasia

With a Little Help From My Friends: the Role of the Renal Collateral Circulation in Atherosclerotic Renovascular Disease

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