Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation11Competition of interest: none.Published online May 29, 2003.

Abstract

Extracorporeal reconstruction and autotransplantation can be effectively used in patients with spontaneous renal artery dissection located in or extending into the distal branches. Early recognition and appreciation of the clinical presentation of spontaneous renal artery dissection are important.

Spontaneous renal artery dissection: three cases and clinical algorithms

“…14,26 Early recognition and appreciation of the clinical presentation of SRAD are important. 28 Generally, long-term prognosis is good. 8,15,28 Anatomic lesions of SRAD are postulated to originate as a result of intramural haemorrhage from the vasa vasorum or by penetration of blood into the arterial wall through an intimal tear.…”

“…28 Generally, long-term prognosis is good. 8,15,28 Anatomic lesions of SRAD are postulated to originate as a result of intramural haemorrhage from the vasa vasorum or by penetration of blood into the arterial wall through an intimal tear. 11 There is also a well-established association between SRAD and FMD.…”

“…29 In fact, several studies reported angiographic improvement of the arterial dissection during the follow-up period. 12,26,[28][29][30] Initial roentgenography is often centred on suspected urinary stones or pyelonephritis. An IVP can lead to abnormal findings, often prompting a CT scan to rule out an abscess or renal infarction.…”

“…15,21 Extracorporeal reconstruction and autotransplantation can be effective in patients with complex SRAD lesions located in or extending into the distal branches. 15,28 Operative intervention on the involved arteries can be difficult secondary to periarterial fibrosis, and in some cases, revascularization can be possible only after renal exteriorization. 15 Postoperative cure or control of hypertension is achieved in most cases.…”

“…15 Postoperative cure or control of hypertension is achieved in most cases. 15,28 Nephrectomy should be considered in the following settings: (a) large renal infarction with significant deterioration of kidney function; (b) severe refractory renovascular hypertension and (c) following failed vascular bypass attempts. 11,22 Failure of endovascular intervention with worsening hypertension can also be considered as a relative indication for nephrectomy, provided that the underlying lesion is not amenable to surgical repair.…”