Cases reported "Aneurysm, Dissecting"

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1/37. Localized dissection and delayed rupture of the abdominal aorta after extracorporeal shock wave lithotripsy.

    Extracorporeal shock wave lithotripsy (ESWL) represents the preferred treatment for most upper ureteric and renal calculi. Complication rates associated with ESWL are low, justifying the enthusiasm and acceptance of this treatment modality. As the technique has become more widely available, some deleterious effects on the kidneys and the surrounding tissues are increasingly recognized. We report on the rupture of a severely calcified abdominal aorta in a 65-year-old man who underwent 3 months of ESWL treatment earlier for renal calculi. The patient was seen with an acute recrudescence of a long-standing abdominal and left flank pain, which began immediately after the last of the three sessions of ESWL and was associated with an episode of hypotension that occurred an hour before admission. Patient history and chronologic course of events strongly suggest the role of ESWL in the genesis of abdominal aorta rupture.
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2/37. Thoracic aortic dissection in a patient with autosomal dominant polycystic kidney disease treated with maintenance hemodialysis.

    A patient with autosomal dominant polycystic kidney disease (ADPKD) on maintenance hemodialysis (HD) experienced spreading back pain with a sudden onset, and was diagnosed with thoracic aortic dissection. Reports of ADPKD with aortic dissection are rare. hypertension, which is essentially universal both among ADPKD and hemodialysis patients, is a known risk factor for aortic dissection. Additionally, some reports have indicated that patients with ADPKD have aortic fragility. We suspect that aortic dissection may be less rare than presently apparent among HD patients with ADPKD.
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3/37. Thoracic aortic dissection in a patient with autosomal dominant polycystic kidney disease.

    Autosomal dominant polycystic kidney disease is one of the most common hereditary diseases, and frequently has well defined extrarenal manifestations. Very few cases of aortic aneurysms associated with this disorder are described in literature. We report a 42-year-old male with autosomal dominant polycystic kidney disease presenting with dissecting aneurysm of the thoracic aorta.
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4/37. Circulatory arrest to protect transplant kidney in a patient with chronic type III dissection.

    With broader indications for renal transplantation and improved allograft survival, it is anticipated that the problem of aortic disease in the post-transplant patient will be encountered with increasing frequency. We report a technique of protecting the transplant kidney from ischemic damage during distal aortic surgery. A 30-year-old renal transplant patient who had undergone an operation for ruptured chronic type III dissection 3 years previously underwent abdominal aortic aneurysm repair under hypothermic circulatory arrest. The patient recovered uneventfully and is presently doing well 1 year after the operation. Hypothermic circulatory arrest could be used in selected cases as a useful alternative for transplant kidney protection.
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5/37. Embolisation of a renal artery pseudoaneurysm in a patient with renal malrotation and chronic aortic dissection.

    INTRODUCTION: renal artery pseudoaneurysms may arise as a complication of percutaneous nephrolithotomy (PCNL). Prompt recognition and treatment is essential to arrest haemorrhage which may be life threatening. CLINICAL PICTURE: A patient with chronic aortic dissection and malrotated right kidney underwent PCNL for right renal calculus. He developed delayed gross haematuria. TREATMENT: angiography showed a pseudoaneurysm arising from one of two right renal arteries, which in turn arose from the false lumen of the aortic dissection. The supplying artery was successfully embolised. CONCLUSION: renal artery pseudoaneurysms can be successfully treated with prompt angiography and embolisation, even in the presence of renal malrotation and aortic dissection.
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6/37. Simultaneous aortoiliac reconstruction and renal transplantation: is it safe?

    A 54-year-old man with an aortoiliac aneurysm and renal failure due to renal artery thrombosis was placed on a transplantation waiting list. The aneurysm had a 3 cm diameter and, therefore, did not require aortoiliac reconstruction, while its evolution was followed by ultrasound color-doppler every six months. The aneurysm was stable and two years later, when a cadaver kidney became available, a preoperative ultrasound color-doppler showed initial wall dissection. Therefore, an abdominal aneurysmectomy using a standard Dacron bifurcation graft and renal transplantation were successfully carried out. The patient had no associated complications and 24 months after transplantation and aneurysmectomy currently has good renal function and distal pulses. Only 20 cases of simultaneous aortoiliac reconstruction and renal transplantation have been reported in the literature. The excellent results of our case and those reported in the literature prove that patients who have both severe aortoiliac disease and end-stage renal failure can safely undergo simultaneous aortic reconstruction and renal transplantation. However, the atherosclerosis in these patients is a generalized process, so that in the pretransplant protocol special attention should be paid to detecting coronary artery atherosclerosis. In fact, coronary artery disease may have a priority claim to therapy because of the high risk of myocardial infarction. Our own policy is to put the patient back on the waiting list for renal transplantation after treatment for coronary artery disease. Furthermore, considering that the management for aortoiliac disease and kidney failure is safe in both simultaneous and staged cases, we think that the real issue is whether or not these patients with coronary atherosclerosis can be candidates for renal transplantation. We believe that each transplant centre has to develop its own general policy for these critically ill patients on the basis of its own experience.
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7/37. Successful renal transplantation after intimal dissection of the renal artery secondary to trauma.

    BACKGROUND: Organ shortage increasingly forces surgeons to consider the use of marginal organs. methods: The authors report a case in which a kidney with traumatic dissection of the renal artery and marginal perfusion by means of collaterals was successfully transplanted into a 63-year-old patient. A computed tomographic scan of the donor showed a marginally perfused left kidney, suggestive of renal artery dissection. After surgical reconstruction of the renal artery, transplantation followed the usual course. RESULTS: The organ started clearing shortly after the operation and was homogeneously perfused in a postoperative scan. creatinine and blood urea nitrogen levels dropped to normal values within a couple of days after the transplantation. During 1 year of follow-up, organ function was always excellent and retention parameters were within the normal range. CONCLUSIONS: This case illustrates that marginally perfused kidneys can be successfully used for transplantation in certain cases.
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8/37. Combined presence of coronary artery ectasia and descending aortic dissection in polycystic kidney disease presenting as acute coronary syndrome.

    We report the unusual case of a 55-year-old man with a history of hypertension and dyslipidemia who presented with acute coronary syndrome. Examination revealed that he had coronary artery ectasia and descending aortic dissection along with polycystic kidney disease.
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keywords = kidney disease, kidney
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9/37. renal artery dissection associated with Gz acceleration.

    A 55-yr-old male presented with flank pain and nausea minutes after intensive aerobatic flight maneuvers. An initial diagnosis of acute appendicitis was made. Computed axial tomography and renal arteriography showed a right kidney with two renal arteries, a right upper pole infarction, and a dissection in the upper renal artery which had a more vertical trajectory than the usual main renal artery. No signs of diseases known to be associated with renal artery dissection were present. The patient recovered without residual hypertension. Heavy positive G loads may have potential to cause renal arterial injury, particularly when renal vascular anatomical variations exist. The postulated mechanism is similar to fall injuries in which the subjects landed on their feet, with inertia causing caudal renal dislodgement and stretch of the renal vessels.
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10/37. Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report.

    BACKGROUND: Medical 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 PRESENTATION: A 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 micromol/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. CONCLUSION: Percutaneous 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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