Aneurysmal Degeneration of an Aortorenal Bypass for Takayasu Renal Artery Stenosis: A Novel Endovascular Intervention

Hu, Huanrui; Chen, Xiyang; Wu, Zhoupeng; Zhao, Jichun; Huang, Bin; Ma, Yukui; Yuan, Daoxian; Yang, Yi; Xiong, Fei

doi:10.1016/j.avsg.2017.12.021

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…There are some case reports of successful open repair; six cases used prosthetic grafts, including four PTFE grafts and two Dacron grafts [ 7 , 10 , 15 - 17 ]. In addition, in 2018, Hu et al [ 18 ] reported a novel endovascular intervention for aortorenal VGA using covered stent and coils, which remained intact after a 12-month follow-up. A covered stent can be deployed when the proximal and distal landing zones are sufficiently long without branching, which was not applicable in our case.…”

Section: Discussionmentioning

confidence: 99%

Vein Graft Aneurysm after Aorto-Renal Bypass for Childhood Renovascular Hypertension Due to Fibromuscular Dysplasia

Cho

Min

2022

Vasc Specialist Int

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Renovascular hypertension (RVHT) is a major cause of surgically correctable secondary hypertension. Refractory hypertension despite multiple antihypertensive drugs requires angioplasty, surgical revascularization, or even nephrectomy. Herein, we report a pediatric patient who had been treated with angioplasty, nephrectomy, and aortorenal bypass surgery for RVHT due to fibromuscular dysplasia and re-do endoaneurysmal graft replacement for a vein graft aneurysm. This case highlights the various treatment modalities for RVHT and the recurrent nature of the disease with a rare presentation of a vein graft aneurysm after aortorenal bypass.

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Section: Discussionmentioning

confidence: 99%

Vein Graft Aneurysm after Aorto-Renal Bypass for Childhood Renovascular Hypertension Due to Fibromuscular Dysplasia

Cho

Min

2022

Vasc Specialist Int

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“…Endovascular treatment is a dynamically growing surgical discipline. It has already found application in many various indications, including management of abdominal aortic aneurysms and arterial hypertension, and with no doubt constitutes a future of modern surgery [5, 15–17]. This explains a growing demand for accurate preoperative morphological data that would facilitate the endovascular treatment.…”

Section: Discussionmentioning

confidence: 99%

“…A growing interest in anatomical variants of renal arteries is not surprising [1–4] considering a progress in kidney surgeries which are performed in the treatment of resistant hypertension and abdominal aortic aneurysms, or as transplantation procedures [5–7]. Modern imaging techniques can provide a detailed and highly accurate information about arterial supply of the kidneys.…”

Section: Introductionmentioning

confidence: 99%

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study

Majos

Polguj

Stefańczyk

et al. 2019

BMC Cardiovasc Disord

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Background Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter. Method The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter. Results R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150–0.5083 and 0.0863–0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants ( p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men ( p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys ( p = 0.3123). Spearman’s coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled − 0.36. Conclusion The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.

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Risk of rupture of an aortorenal vein graft aneurysm after the surgical repair of Takayasu arteritis-induced right renal artery stenosis

Chen

Huang²,

Yuan³

et al. 2019

Medicine

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Introduction: Takayasu arteritis (TA) is a chronic and nonspecific inflammatory disease mainly affecting the aorta and its major branches, resulting in the stenosis or occlusion of target arteries. Approximately 50% to 60% of patients with TA likely have renal artery stenosis (RAS), which results in refractory hypertension (HTN) and renal dysfunction. Aortorenal bypass with saphenous vein graft (SVG) is the classical procedure to relieve patients’ symptoms. Graft restenosis is the most common complication during long-term follow-up. However, aortorenal vein graft aneurysm (AVGA) is uncommonly reported, and symptomatic or ruptured AVGA that needs reoperation is even rarer. Long-term follow-up results after AVGA reoperation also remain scare. Here, we introduced the long-term result of a symptomatic AVGA under the reoperation of polytetrafluoroethylene (PTFE) graft replacement and provided a literature review of AVGA reoperation after surgical bypass for RAS. Clinical finding: An 18-year-old male complained about mild to severe right lumbar pain for 5 days. He underwent right aortorenal bypass with SVG for TA-induced right renal artery stenosis to relieve refractory HTN and renal dysfunction 2 years ago. However, this patient did not proceed with a follow-up after the procedure. Physical examination showed normal vital signs, and an obvious percussion tenderness over the right kidney region was detected. The updated computed tomography angiography (CTA) revealed a right AVGA with a maximum diameter of 26 mm. No restenosis of the proximal and distal anastomoses was detected. Diagnosis: The patient was diagnosed to have right aortorenal vein graft aneurysm at the risk of rupture and Takayasu arteritis. Interventions: The AVGA was resected with a 6 mm PTFE graft replacement. An end-to-side proximal anastomosis to the orifice of the original anastomosis on the abdominal aorta and an end-to-end distal anastomosis to the distal normal renal artery were made. Outcomes: The patient had an uneventful postoperative clinical course and was discharged from the hospital 5 days after the operation. The 4-year updated CTA revealed no restenosis or aneurysmal degeneration of the prosthetic graft. Conclusion: Symptomatic AVGA that needs reoperation is rare. Prosthetic graft replacement is an effective way to eliminate the risk of potential rupture. A 4-year satisfactory result indicative of a prosthetic graft can be the first choice for aortorenal bypass in RAS without active biological inflammation.

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Aneurysmal Degeneration of an Aortorenal Bypass for Takayasu Renal Artery Stenosis: A Novel Endovascular Intervention

Cited by 3 publications

References 15 publications

Vein Graft Aneurysm after Aorto-Renal Bypass for Childhood Renovascular Hypertension Due to Fibromuscular Dysplasia

Vein Graft Aneurysm after Aorto-Renal Bypass for Childhood Renovascular Hypertension Due to Fibromuscular Dysplasia

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study

Risk of rupture of an aortorenal vein graft aneurysm after the surgical repair of Takayasu arteritis-induced right renal artery stenosis

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