Cases reported "Renal Artery Obstruction"

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11/263. Isolated metachronous renal artery emboli.

    We have reported on a patient with isolated metachronous renal artery emboli. The second embolus was treated successfully surgically 12 hours after the onset of symptoms. A review of the literature shows that emboli to the renal arteries occur more frequently than realized and that late embolectomy often is successful. A clinical triad of flank pain, atrial fibrillation, and nonfunctioning of the involved kidney has been discussed.
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12/263. Dramatic recovery of renal function after 6 months of dialysis dependence following surgical correction of total renal artery occlusion in a solitary functioning kidney.

    Revascularization of renal artery stenosis for the treatment of hypertension is an established procedure. In selected clinical scenarios, successful revascularization procedures may preserve or restore renal function. We present a 31-year-old man who underwent successful renal revascularization of a solitary functioning kidney after being dialysis dependent for approximately 190 days. He had dramatic improvement of renal function and has remained off dialysis since his surgery 18 months ago. He continues to have severe but controllable hypertension.
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13/263. Trapped renal arteries: functional renal artery stenosis due to occlusion of the aorta in the arch and below the kidneys.

    Acute renal failure is a well recognized complication from the use of angiotensin-converting enzyme inhibitors in patients with severe bilateral renovascular disease. A 54-year-old woman presented with acute pulmonary edema with intractable hypertension and a history of lower limb claudication. The addition of lisinopril to her antihypertensive regimen resulted, within 48 h, in the development of acute renal failure that remitted with cessation of the drug. She was found to have a heavily calcified occlusion of her aortic arch and another occlusion of the aorta below the renal arteries. angiography and Doppler ultrasonography showed normal renal arteries. This is the first reported case of angiotensin-converting enzyme inhibitor-induced renal failure occurring in a patient with atherosclerotic occlusion of the aorta. The literature on suprarenal aortic occlusion is reviewed to determine the manner of presentation, prevalent risk factors and physical findings that typify this unique clinical entity.
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14/263. Perinuclear-antineutrophil cytoplasmic antibodies are associated with vasculitis.

    We describe a 62-year-old man with perinuclear-antineutrophil cytoplasmic antibodies-associated vasculitis, which involved the heart, lung, and kidneys. The patient's care was complicated by total occlusions of the brachiocephalic and right renal arteries and a stenosis of the left renal artery. Involvement of large-sized vessels has not been reported in patients with perinuclear-antineutrophil cytoplasmic antibodies-associated vasculitis.
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15/263. Tc-99m-DTPA captopril renography in the detection of renovascular hypertension due to renal polar artery stenosis.

    A 24-year-old man whose clinical features were suggestive of renovascular hypertension was referred for captopril renal scintigraphy. captopril renal scintigraphy was positive for renovascular hypertension only when the left kidney was analyzed in 2 separate regions. angiography confirmed severe stenosis (90%) in the upper branch of the left renal artery.
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16/263. Presentation and revascularization outcomes in patients with radiation-induced renal artery stenosis.

    This study analyzed the initial presentation and revascularization outcomes of patients with radiation-induced renal artery stenosis, a rare complication of therapeutic irradiation. Of 11 patients with renal artery stenosis after irradiation, 7 patients fulfilled the following criteria: normotension before irradiation, radiation dose greater than 25 grays delivered to the renal arteries, associated perirenal radiation-induced lesions, and absence of arterial disease outside the radiation field. The median age at irradiation was 30 years, and the median local irradiation dose was 40 grays. The median time from irradiation to referral was 13 years. All patients were hypertensive at referral, with a median blood pressure (BP) of 171/102 mm Hg and median treatment score of two. The median glomerular filtration rate was 67 mL/min. Two patients had bilateral stenoses and 1 patient had stenosis affecting a single kidney. Stenoses were proximal in 6 patients and truncal in 1 patient, and all had the appearance of atherosclerotic stenosis. Percutaneous transluminal renal artery angioplasty (PTRA) was successful in 5 patients, but required multiple insufflations. PTRA failed in 1 patient, who subsequently underwent an aortorenal bypass. After a median follow-up of 36 months, 2 patients had died of noncardiovascular causes and 4 patients remained hypertensive, with a median BP of 136/85 mm Hg and median treatment score of two. No restenosis occurred, but aneurysms developed at the site of angioplasty in 1 patient. If hypertension occurs even decades after irradiation, a radiation-induced renal artery stenosis should be sought in patients who have undergone abdominal irradiation.
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17/263. Massive hematuria due to right renal artery mycotic pseudoaneurysm in a patient with subacute bacterial endocarditis.

    A 40-year-old woman with recently diagnosed bacterial endocarditis was admitted to the hospital with gross hematuria and anemia. Computed tomography revealed a large right upper pole renal artery pseudoaneurysm, a wedge-shaped hypoperfused region of the left kidney, and a splenic abscess. Radiographic embolization of the right renal artery was performed to stabilize the bleeding. The splenic abscess was drained. Subsequent right nephrectomy and splenectomy were performed for persistent leukocytosis. This unusual presentation of a septic embolus and its management are discussed.
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18/263. renal artery stenosis: a complication of needle puncture for manometry. Case of subintimal dissection with spontaneous resolution.

    After aortorenal bypass for renovascular hypertension secondary to atherosclerosis of the renal artery of a solitary left kidney a high-grade stenosing lesion developed distal to the site of insertion of a Dacron graft. In the immediate postoperative period the blood pressure was restored to normal, but one week later hypertension recurred. An arteriogram disclosed an area of stenosis 1 cm distal to the site of insertion of the graft in the renal artery. During the next year, serial arteriograms were made, renal function remained normal, and hypertension gradually abated. One year after the discovery of the postbypass stenosis, an arteriogram showed disappearance of the constricting lesion. The postoperative stenosis was, in all probability, caused by subintimal dissection secondary to needle puncture for strain gauge manometry.
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19/263. Endovascular stent placement for management of total renal artery occlusion in a child.

    Total renal artery occlusion is a rare complication of percutaneous transluminal angioplasty. An 8-year-old boy was referred due to left renal artery stenosis after unsuccessful balloon angioplasty. Total left renal artery occlusion was diagnosed by angiography. The combination of balloon angioplasty and stent placement allowed reestablishment of perfusion and salvage of a severely threatened kidney. His blood pressure improved after the procedure and returned to normal 3 months later. The patient has remained free of symptoms for 12 months without medication.
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20/263. Preventive stent placement for renal artery stenosis prior to emergent coronary artery bypass grafting.

    PURPOSE: To illustrate the benefits of treating severe renal artery stenosis in renally compromised patients prior to surgery for coronary artery disease. CASE REPORT: A 63-year-old woman with unstable angina, severe coronary artery disease, and long-term severe renal impairment with a single functioning kidney underwent renal stent placement for high-grade renal artery stenosis prior to coronary artery surgery. The procedure improved her serum creatinine from 528 micromol/L at baseline to 385 micromol/L, and she subsequently underwent coronary artery bypass grafting without deterioration in her renal function. At 1 year, the patient has a serum creatinine of 400 micromol/L, and there is no evidence of in-stent stenosis. Conclusions: Percutaneous renal angioplasty or stenting prior to coronary surgery in patients with concomitant renal and coronary artery disease may reduce perioperative renal deterioration in this specific group of patients.
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