Percutaneous recanalization of a renal artery in aortic dissection.

Lacombe, Pascal; Mulot, R.; Labedan, F; Jondeau, Guillaume; Barré, Olivier; Chagnon, S; Judet, Olivia; Tcherdakoff, P

doi:10.1148/radiology.185.3.1438771

Cited by 24 publications

(8 citation statements)

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“…Aortic dissection often results in vascular complications, such as stroke and visceral ischemia [21]. Renal complications secondary to aortic dissection are relatively common [5], yet there are few reports on aortic dissection with concomitant AKI requiring RRT [7–10, 20, 22, 23]. The aetiologies of severe AKI due to aortic dissection in these reports were mostly limited to static obstructions (see Fig.…”

Section: Discussionmentioning

confidence: 99%

“…1b) [5, 6]. Surgical interventions for aortic dissection have rescued patients from ESKD [7–10]; these patients had static renal artery obstructions, confirmed by imaging, secondary to aortic dissections. Here, we present the first report of a patient who experienced RRT dependency for 3 months due to an aortic dissection without any imaging findings suggestive of static renal artery obstruction; his “ temporary ” ESKD unexpectedly resolved following aortic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study

et al. 2019

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Background Acute kidney injury (AKI), which may progress to end-stage kidney disease (ESKD), is a potential complication of aortic dissection. Notably, in all reported ESKD cases secondary to aortic dissection, imaging evidence of static obstruction of the renal arteries always shows either renal artery stenosis or extension of the dissection into the renal arteries. Case presentation We present the case of a 58-year-old man with hypertension who was diagnosed with a Stanford type B aortic dissection and treated with medications alone because there were no obvious findings indicative of dissection involving the renal arteries. He had AKI, which unexpectedly progressed to ESKD, without any radiological evidence of direct involvement of the renal arteries. Thus, we failed to attribute the ESKD to the dissection and hesitated to perform any surgical intervention. Nevertheless, the patient’s hormonal levels, fractional excretion values, ankle brachial indices, and Doppler resistive indices seemed to indirectly suggest kidney malperfusion and implied renal artery hypo-perfusion. However, abdominal computed tomography imaging only revealed progressive thrombotic obstruction of the false lumen and compression of the true lumen in the descending thoracic aorta, despite the absence of anatomical blockage of renal artery perfusion. Later, signs of peripheral malperfusion, such as intermittent claudication, necessitated surgical intervention; a graft replacement of the aorta was performed. Post-operatively, the patient completely recovered after 3 months of haemodialysis, and the markers that had pre-operatively suggested decreased renal bloodstream normalised with recovery of kidney function. Conclusions To the best of our knowledge, this is the first report of severe AKI, secondary to aortic dissection, without direct renal artery obstruction, which progressed to “temporary” ESKD and was resolved following surgery. This case suggests that only coarctation above the renal artery branches following an aortic dissection can progress AKI to ESKD, despite the absence of radiological evidence confirming an obvious anatomical blockage. Further, indirect markers suggestive of decreased renal blood flow, such as ankle brachial indices, renal artery resistive indices, urinary excretion fractions, and hormonal changes, are useful for evaluating concomitant AKI and may indicate the need for surgical intervention after a Stanford type B aortic dissection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study

et al. 2019

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“…The patient had been on hemodialysis for 2.5 months prior to the intervention and subsequently recovered enough renal function to discontinue hemodialysis shortly after the intervention [7]. Three other cases reports have documented utilization of percutaneous intervention to the renal arteries to halt ischemia- related renal injury caused by aortic dissection, but none of these patients had suffered from apparent end-stage renal disease prior to the intervention [5,8,9]. Our case documents a patient with ischemic involvement of both kidneys as a consequence of dissection with reversal of apparent end-stage renal disease after endovascular reconstruction with stent placement to the renal artery.…”

Section: Discussionmentioning

confidence: 99%

Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

2004

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BackgroundMedical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD).Case presentationA 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L) on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement.ConclusionPercutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.

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“…Moreover, some recent reports have mentioned good results in percutaneous treatment of acute type B [5][6][7][8][9] or traumatic [2,10] dissections, preventing ischemic complications.…”

Section: Discussionmentioning

confidence: 99%

Dissection of the Abdominal Aorta in Blunt Trauma: Management by Percutaneous Stent Placement

Vernhet

Marty-Ané

Lesnik

et al. 1997

Cardiovasc Intervent Radiol

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We implanted stents in three patients who had traumatic abdominal aortic dissections, complicated by right limb ischemia in one case. The circulating false channel extended to the left iliac artery in one case and to both iliac arteries in the last case. Diagnosis and radiological follow-up included ultrasound, computed tomography, and arteriography. Two patients were treated with Wallstents, one with a Palmaz stent. The occlusion of the false channel was obtained in all patients without any significant residual stenosis. No early or late complication was noted in any of the patients. The longest follow-up was 2 years. We conclude that stent placement is an efficient method for the treatment of noniatrogenic inframesenteric aortic dissections.

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Percutaneous recanalization of a renal artery in aortic dissection.

Cited by 24 publications

References 0 publications

Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study

Complete post-operative resolution of “temporary” end-stage kidney disease secondary to aortic dissection without static renal artery obstruction: a case study

Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

Dissection of the Abdominal Aorta in Blunt Trauma: Management by Percutaneous Stent Placement

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