Renal Parenchymal Tolerance to Artery Occlusion

Pk, Donahoe; Jd, Osmond; Dr, Stewart; Wh, Hendren

doi:10.1097/00000658-197308000-00005

Cited by 15 publications

(4 citation statements)

References 7 publications

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“…We have demonstrated robust angiogenesis in a model of diet-induced hypercholesterolemia, involving increased density and sprouting of intrarenal microvessels, likely secondary to inflammation. 19 Angiogenesis also contributes significantly to blood supply in the ischemic rat kidney, 20 and hallmarks of atheromatous-related ischemia, such as oxidative stress and inflammation, promote kidney neovascularization, which may imply a comparable role for de novo vessel formation in collateralization. 21,22 However, although small vessels generated through angiogenesis may ameliorate ischemia, they may be unable to fully restore blood flow in the ischemic kidney.…”

Section: Collateral Formation In Arvdmentioning

confidence: 99%

“…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][46][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%

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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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Section: Collateral Formation In Arvdmentioning

confidence: 99%

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 role of the collateral circulation in the “peri-stenotic” milieu in RVD remains largely unknown. Peri-arterial collateral vessel recruitment and formation are important potential mechanisms to compensate for a vascular stenosis and restore blood supply to distal ischemic tissues 49 . Collateral vessel development in other settings is characterized by active DNA synthesis in response to inflammation, ischemia, or changes in shear stress, all common features of RVD 50 .…”

Section: Current Paradigmsmentioning

confidence: 99%

Emerging Paradigms in Chronic Kidney Ischemia

2018

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“…We did not obtain radiological data immediately after arterial occlusion, but Donahoe et al 1 have demonstrated preexisting collaterals by angiography within an hour after division of the renal artery in the rat. These investigators found that new channels are progressively added to preexisting vessels over the period of 8-97 days after arterial occlusion.…”

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confidence: 90%

Collateral circulation after renal artery occlusion in the rat.

Siegel¹,

Levinsky²

1977

Circulation Research

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SUMMARY We used angiographic and microsphere methods to evaluate the anatomic and functional features of renal collateral circulation in the rat. By the microsphere method, renal parenchymal blood flow was less than 1% of control 1 hour after occlusion of the main renal artery; 2.8% of control 1-2 weeks after arterial occlusion; and 1% of control 4-9 weeks after occlusion. Radiographic observations during chronic occlusion revealed numerous collateral vessels to the kidney. These vessels readily filled with angiographic contrast medium but the intrarenal circulation did not visualize. We conclude that collateral circulation to renal parenchyma is negligible after acute or chronic occlusion of the main renal artery in the rat. The rich anatomic plexus of collateral vessels has no functional significance and is unable to preserve viability of the parenchyma.MANY ANATOMICAL and radiographic studies demonstrate that collateral vessels are present after occlusion of the renal artery in the rat and the dog. "6 However, there are few measurements of the actual rate of blood flow through these collateral channels. To evaluate the functional significance of collateral circulation in the rat, we have visualized collateral vessels angiographically and quantitated nutrient flow to the renal parenchyma with microspheres. Although impressive collateral vessels develop during arterial occlusion, parenchymal blood flow is negligible. Methods MEASUREMENT OF RENAL BLOOD FLOW WITH MICROSPHERESFor chronic studies, male Sprague-Dawley rats, weighing 210-400 g and allowed free access to food and water, were anesthetized with methohexital (100 mg/kg). A left flank incision was made and the renal artery was carefully separated from the renal vein near its origin from the abdominal aorta. Care was taken not to disrupt perirenal structures. The renal artery was tied at two separate locations with 4-0 silk. The proximal tie was as close to the aorta as possible and was proximal to any identifiable branches of the renal artery. Any rats in which the entire kidney did not blanch uniformly were discarded. Five to 60 days later, these rats were anesthetized with Inactin (ethyl-(l-methyl-propyl)-malonylthiourea) (100 mg/kg, ip). A tracheostomy tube (PE 240) was inserted and the right jugular vein was cannulated with PE 50 tubing for infusion of heparinized saline at 0.028 ml/min (6 units of aqueous heparin/ml). A second PE 50 cannula was placed into the right femoral artery and connected to a pressure transducer and recorder. A third PE 50 cannula was placed into the left axillary artery and advanced to the junction of this artery and the aorta. Rats were maintained at normal body temperature throughout the experiment by use of thermostatically controlled heating coil and esophageal sensing probe. One-half hour after the above surgery had been completed, a timed 60-second free-flow collection of blood was begun from the right femoral artery cannula under oil into a preweighed plastic test tube. The total volume of blood collected was 1 ml or l...

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Renal Parenchymal Tolerance to Artery Occlusion

Cited by 15 publications

References 7 publications

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

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

Emerging Paradigms in Chronic Kidney Ischemia

Collateral circulation after renal artery occlusion in the rat.

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