Can renal dimensions and the main renal artery diameter point to the presence of an accessory renal artery? a 64-slice CT study

Ramadan, Selma Uysal; Yiğit, Hasan; Gökharman, Dilek; Tunçbilek, Işıl; Dolgun, N. Anil; Koşar, Pınar Nercis; Koşar, Uğur

doi:10.4261/1305-3825.dir.3507-10.0

Cited by 12 publications

(14 citation statements)

References 20 publications

(49 reference statements)

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“…In this sample, 35.7% of the patients had more than one renal artery on the right or left side, a figure that is within the range of frequencies from other studies. 25 In 18.6% of the patients, a ‘main artery’ was no more than 2 cm long, and in 34.1% of the patients, the diameter was <4 mm at a location <2 cm from the ostium, so that after exact measurement, taking the three patients with fibromuscular dysplasia into account, 58.7% of the patients in this study would not be eligible for denervation according to the Symplicity criteria, 19 and 46.2% would still not be eligible according to the European Network Coordinating Research on Renal Denervation criteria. 29 This figure is more than twice the magnitude indicated in the renal denervation studies.…”

Section: Discussionmentioning

confidence: 99%

“…The smaller the diameter of a renal artery is, the greater the probability that a second renal artery will be found. 25 Some 12.8% of renal arteries have a diameter of<3 mm, 2.5% <2 mm and 0.4% <1.5 mm, which makes ablation considerably more difficult or impossible, even with the latest devices. In cases such as this, a percutaneous, not transarterial approach, could be a possible option that is currently being tested in various studies.…”

Section: Discussionmentioning

confidence: 99%

“… 23 24 Diameters and lengths are dependent on gender 23 and on the presence of additional vessels. 25 The data do not reflect the curvature of the vessels in the area, the resulting ovality of the inner lumen, the wall lengths that vary between larger and smaller circumferences, or the fluctuation of the diameters along the course of the vessel. The aims of this study were, therefore, in view of the new techniques of renal denervation, to precisely determine the length, diameter, implantation angle and lumen ovality of renal arteries of humans in vivo, and the impact these features can have on renal denervation.…”

Section: Introductionmentioning

confidence: 93%

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Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

Schönherr

Rehwald

Nasseri³

et al. 2016

BMJ Open

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ObjectiveThe aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials.Design and settingIn a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies.ResultsAmong the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p<0.0001), but had a slightly larger diameter (5.2±1.4 mm (CI 4.9 to 5.4) vs 4.9±1.2 mm (CI 4.6 to 5.1); p>0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p<0.05). Ostial funnels were up to 14 mm long. The cross-sections were elliptical, more pronounced on the right side (p<0.05). In 23 cases (18.3%), the main artery was shorter than 2 cm; in 43 cases (34.1%), the diameter was not >4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation.ConclusionsBased on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

See 1 more Smart Citation

Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

Schönherr

Rehwald

Nasseri³

et al. 2016

BMJ Open

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“…The imaging should be reviewed carefully, in axial and coronal planes, for the presence of accessory renal arteries which may be identified in greater than 20% of cases [20]. Accessory renal arteries become important because if such an artery is not occluded during hilar clamping, then substantial arterial bleeding can occur during tumor resection.…”

Section: Resultsmentioning

confidence: 99%

Description of a multicenter safety checklist for intraoperative hemorrhage control while clamped during robotic partial nephrectomy

et al. 2012

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BackgroundThe adoption of robotic assistance has contributed to the increased utilization of partial nephrectomy for the management of renal tumors. However, partial nephrectomy can be technically challenging because of intraoperative hemorrhage, which limits the ability to identify the tumor margin and may necessitate the conversion to open surgery or radical nephrectomy. To our knowledge, a comprehensive safety checklist does not exist to guide surgeons on the management of hemorrhage during robotic partial nephrectomy. We developed such an safety checklist based on the cumulative experiences of high volume robotic surgeons.MethodsA treatment safety checklist for the management of hemorrhage during robotic partial nephrectomy was collaboratively developed based on prior experiences with intraoperative hemorrhage during robotic partial nephrectomy.ResultsReducing the risk of hemorrhage during robotic partial nephrectomy begins with reviewing the preoperative imaging for renal vasculature and tumor anatomy, with a focus on accessory vessels and renal tumor proximity to the renal hilum. During hilar exposure, an attempt is made to identify additional accessory renal arteries. The decision is then made on whether to clamp the hilum (artery +/- vein). If bleeding is encountered during resection, management is based on whether the bleeding is suspected to be arterial or from venous backbleeding. Operative maneuvers that may increase the chance of success are highlighted in safety checklists for arterial and venous bleeding.ConclusionsSafely performing robotic partial nephrectomy is dependent on attention to prevention of hemorrhage and rapid response to the challenge of intraoperative bleeding. Preparation is essential for maximizing the chance of success during robotic partial nephrectomy.

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“…Dorsal IOMs are sonographically detectable through metacarpal interspaces from the dorsum of the hand. IOMs are observed between metacarpals as a smooth contour in a hypo-echoic structure [4]. It is known that CTS symptoms develop due to compression of the median nerve.…”

Section: Introductionmentioning

confidence: 99%

Can decrease in hand grip strength in carpal tunnel syndrome be explained by interosseous muscle and intermetacarpal space dimensions?

Gökharman

Ramadan²,

Aydın

et al. 2017

The European Research Journal

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Objectives. To investigate the correlation of the grip strength with sonographic measurement of interosseous muscle (IOM) and intermetacarpal space (IMS) of the hands in carpal tunnel syndrome (CTS) patients. Methods. A total of 96 hands of 48 female patients constituted the study group. Of those, 36 hands of 18 patients (mean age: 50.2 ± 9 years) had CTS confirmed by electro-diagnostic tests. Sixty hands of 30 healthy volunteers (mean age: 45.2 ± 9.7 years) constituted the control group. Grip strength was assessed by Jamar hand dynamometer. IOM and IMS dimensions for all hands were measured sonographically at three levels (2 nd , 3 rd and 4 th intermetacarpal; palmar side for IMS, dorsal side for IOM) by the same radiologist. Spearman and Mann Whitney U tests were used for statistical analysis. Results. The median hand grip strength was determined as 11.3 kg (min-max = 7.2-18.1 kg) in the CTS group and 19.5 kg (min-max = 7.8-30.5 kg) in the control group, with a statistical difference between the two groups (p < 0.03). In both groups, there was a positive correlation between the IOM-IMS dimensions and grip strength (p < 0.05). Sonographically, IOM-IMS measurements in CTS group were significantly lower than control group (p < 0.01). Conclusion. To our knowledge, this is the first study evaluating the correlation of grip strength and the sonographic IOM-IMS measurements in CTS patients. The muscular atrophy, which is generally a finding of advanced disease, may be revealed by sonographical measurements earlier than the physical examination findings.

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Can renal dimensions and the main renal artery diameter point to the presence of an accessory renal artery? a 64-slice CT study

Cited by 12 publications

References 20 publications

Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

Description of a multicenter safety checklist for intraoperative hemorrhage control while clamped during robotic partial nephrectomy

Can decrease in hand grip strength in carpal tunnel syndrome be explained by interosseous muscle and intermetacarpal space dimensions?

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