1/61. Staged thoracic and abdominal aortic aneurysm repair using stent graft technology and surgery in a patient with acute renal failure.A 52-year-old male presented with severe hypertension and acute renal failure. carbon dioxide (CO(2)) angiography identified a saccular thoracic aortic aneurysm, right renal artery stenosis, left renal artery occlusion, an infrarenal aortic aneurysm, celiac artery, and inferior mesenteric artery (IMA) orificial stenoses. Via an anterior retroperitoneal approach, bilateral renal artery thromboendarterectomy, infrarenal aortic aneurysmectomy, and IMA reimplantation were performed. The patient's tortuous iliac arteries were straightened to permit future passage of a thoracic stent graft by mobilizing the aortic bifurcation and anastomosing it to a Dacron graft within 4 cm of the renal vessels. Two weeks later, a stent graft was placed via a femoral incision utilizing CO(2) angiography, successfully excluding the saccular thoracic aneurysm. Recovery from both procedures was quick, with rapid return of renal function, and alleviation of the hypertension. At 8 months follow-up, his renal arteries and aorta are patent.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/61. fibromuscular dysplasia: a rare cause of cilioretinal artery occlusion in childhood.OBJECTIVE: To report a case of cilioretinal artery occlusion with angiographic findings characteristic of the "string of beads" associated with renovascular hypertension secondary to fibromuscular dysplasia of the renal artery in a child. DESIGN: Case report. INTERVENTION: The patient underwent ex vivo renal artery reconstruction with saphenous vein graft and reimplantation. MAIN OUTCOME MEASURES: The main clinical outcomes were control of severe hypertension, reversible hypertensive retinopathy, and improvement of vision. RESULTS: Revascularization of the kidney improved renal function, and renovascular hypertension was clearly improved. visual acuity improved to 20/200. CONCLUSIONS: A child with hypertensive retinopathy and arterial occlusion in the retina should undergo investigation to rule out a surgically curable hypertension. magnetic resonance angiography of extrarenal vessels may reveal other sites of involvement of fibromuscular dysplasia. Evaluation and early diagnosis of renovascular hypertension will prevent severe end-organ damage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/61. Endovascular treatment of multiple visceral artery paradoxical emboli with mechanical and pharmacological thrombolysis.PURPOSE: To report a case of paradoxical emboli to multiple visceral vessels treated with both mechanical (AngioJet device) and pharmacological (urokinase) thrombolysis. methods AND RESULTS: A 72-year-old man presented with a 48-hour history of symptomatic right renal ischemia, which was treated with heparinization. Five days later, an abrupt creatinine elevation prompted arteriography, which demonstrated thromboembolism of the superior mesenteric artery (SMA) and both renal arteries. The AngioJet aspiration device was employed to successfully remove the clot from the SMA; urokinase infusion restored flow to the left kidney. At the 16-month follow-up evaluation, the patient was normotensive without medication and had a stable creatinine (1.4 mg/dL). CONCLUSIONS: Because of its speed and minimal morbidity, the AngioJet device may be an attractive alternative to surgical embolectomy or pharmacological thrombolysis in highly selected cases of acute visceral artery thromboembolism.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/61. Large artery vasculitis following recombinant hepatitis b vaccination: 2 cases.We describe 2 women who developed large artery vasculitis shortly after receiving recombinant hepatitis b vaccination. One patient developed Takayasu's arteritis, the other a vasculitis involving subclavian and renal arteries. Both developed renal failure. Whether the vasculitis was caused by the vaccination is not known. Although small vessel vasculitis following hepatitis b vaccination has been reported a number of times, large vessel vasculitis associated with hepatitis b vaccination has been reported only once. These cases suggest that large artery vasculitis should be added to the list of possible side effects of hepatitis b vaccination.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/61. 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.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/61. Anesthetic management of patients with Takayasu's arteritis: a case series and review.Takayasu's arteritis is a rare, chronic progressive panendarteritis involving the aorta and its main branches. anesthesia for patients with Takayasu's arteritis is complicated by their severe uncontrolled hypertension, end-organ dysfunction resulting from hypertension, stenosis of major blood vessels affecting regional circulation, and difficulties encountered in monitoring arterial blood pressure. Takayasu's arteritis is an uncommon disease and previous descriptions of the anesthetic management of patients with this disease have been limited to isolated case reports in the anesthetic literature, mostly in women undergoing cesarean delivery. We present our experience in this series of eight patients for various emergency and elective surgical procedures and review their perioperative problems and management. Implications: This case series describes the anesthetic problems and management of patients with pulseless disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/61. Staged reconstruction for middle aortic syndrome.BACKGROUND/PURPOSE: Middle aortic syndrome is a rare condition that involves narrowing of the abdominal aorta and its visceral branches. The authors propose staged vascular repair to minimize renal ischemia and facilitate use of native arterial tissue for reconstruction. methods: Three adolescents (age 8(1/2), 12(1/2), 13(1/2)) presented with severe hypertension. Subsequent evaluation showed coarctation of the abdominal aorta extending above the celiac axis. All 3 patients had bilateral renal artery stenoses. There also were tight stenoses of the celiac or superior mesenteric arteries. In the first stage the right renal artery stenosis was relieved. In the youngest patient, this was accomplished by balloon angioplasty. However, in the other 2, right renal autotransplantation was performed to the right iliac vessels using end-to-side anastomoses of the renal artery and vein. Cold perfusion was used. The second stage was performed 2 to 5 months later via a thoracoabdominal approach in 2 patients. A Dacron tube graft was utilized from above the coarctation to the iliac bifurcation. The left renal arteries were detached and anastomosed end to side to the bypass graft. In 1 child there were actually 3 separate renal arteries that required reimplantation. In the youngest patient the aortic narrowing was relieved by a long Dacron patch aortoplasty and interposition of an internal iliac artery graft to the left renal artery. RESULTS: All 3 patients recovered well and returned to full activities. There was no measurable rise of BUN or serum creatinine postoperatively. Postoperative renal scans showed good renal perfusion bilaterally. Follow-up results 2 to 10 years later continue to show well functioning reconstructions. CONCLUSION: A staged approach is an effective reconstruction for children with middle aortic syndrome which minimizes risk to renal function.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/61. pheochromocytoma with renal artery stenosis and high plasma renin activity.An unusual case of pheochromocytoma is described in this communication. Besides a chain of typical clinical pictures and laboratory findings which suggested a catecholamine-producing tumor, the left renal artery stenosis was demonstrated by an aortography and the plasma renin activity was consistently elevated. Surgery revealed the left renal artery was embedded in the tumor mass, originated from the left adrenal gland, resulting in a high degree of constricture of the vessel. Following the removal of the tumor, blood pressure immediately returned to normal, however, plasma renin activity remained elevated as long as 9 months of the follow-up study. The second aortography performed 14 months after the operation failed to demonstrate the left renal artery stenosis and subsequent studies revealed that plasma renin activity was gradually declining to upper normal levels. It is suggested that an excess of catecholamines secreted by the tumor was responsible for hypertension in this case, and that another factor, probably renal artery stenosis, was involved in the elevation of plasma renin activity, although this high renin activity was maintained for more than 9 months following the tumor extirpation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/61. Superior mesenteric artery-to-renal artery bypass: a rare but useful alternative for renal artery revascularization.The aorta, celiac axis, and iliac arteries are the most common inflow arteries used for renal revascularization. When these inflow vessels are diseased, the superior mesenteric artery (SMA) can be an alternative source of renal artery graft inflow. Previous reports have suggested that only an enlarged SMA should be used for this purpose, for fear of developing mesenteric ischemia. We report a patient who required renal artery revascularization with a saphenous vein graft from a normal-caliber SMA who did not develop subsequent mesenteric ischemia. The procedure was unique in demonstrating that the SMA can be used as a viable source of graft inflow even when it is anatomically normal.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/61. Late aortic dislocation of a stent following stent angioplasty for ostial renal artery stenosis.A patient with left RAS was treated by stent angioplasty followed by a multivessel percutaneous coronary intervention. Six months later, an aortic dislocation of the stent was diagnosed. The fully expanded stent was caught with a balloon catheter and fixed in the left external iliac artery. Stent migration after initially successful stent angioplasty for RAS is possible. Fully expanded, dislocated balloon-expandable stents can be secured by implanting them into the iliac artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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