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Triantafyllou G, Paschopoulos I, Węgiel A, Olewnik Ł, Tsakotos G, Zielinska N, Piagkou M. The accessory renal arteries: A systematic review with meta-analysis. Clin Anat 2024. [PMID: 39648312 DOI: 10.1002/ca.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 11/01/2024] [Accepted: 11/30/2024] [Indexed: 12/10/2024]
Abstract
The accessory renal arteries (ARAs) are a well-described variant of the renal vasculature with clinical implications for radiologists, surgeons, and clinicians. The aim of the present systematic review with meta-analysis was to estimate the pooled prevalence of ARAs, including their variant number, origin, and termination, and to highlight symmetrical and asymmetrical morphological patterns. The systematic review used four online databases in accordance with PRISMA 2020 and Evidence-based Anatomy Workgroup guidelines. R programming software was used for the statistical meta-analysis. A total of 111 studies were considered eligible for our initial aim. The typical renal artery (RA) anatomy (a single bilateral vessel) was identified in 78.92%; the overall ARA prevalence was estimated at a pooled prevalence of 21.10%. The estimated pooled prevalence of one, two, three, and four ARAs were 18.67%, 1.80%, 0.01%, and <0.01%. The ARAs have been the subject of extensive research owing to their clinical importance, including in kidney transplantation surgery and resistant hypertension therapy. Knowledge of the typical and variant anatomy of RAs is essential for anatomists, radiologists, surgeons, and clinicians in order to avoid misunderstanding, complications, and iatrogenic injury.
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Affiliation(s)
- George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Paschopoulos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrzej Węgiel
- Department of Clinical Anatomy, Masovian Academy in Płock, Płock, Poland
| | - Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, Płock, Poland
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicol Zielinska
- Department of Clinical Anatomy, Masovian Academy in Płock, Płock, Poland
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Wang L, Xie Y, Kong D, Li K, Lai Z, Shao J, Zeng R, Di X, Ni L, Zheng Y, Liu B. Multiple Treatment Strategies of Accessory Renal Artery Related Hypertension: Report of Two Cases and Literature Review. J Clin Hypertens (Greenwich) 2024; 26:1449-1456. [PMID: 39545713 DOI: 10.1111/jch.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/29/2024] [Accepted: 09/29/2024] [Indexed: 11/17/2024]
Abstract
Renovascular hypertension (RVH) is a primary cause of secondary hypertension, primarily driven by the activation of the renin-angiotensin-aldosterone system activation. Recently, growing studies suggested accessory renal artery (ARA) might also contribute to RVH. However, the treatment of ARA-related hypertension and whether to take interventional treatment lack consensus. Herein, we report two cases of ARA-related hypertension in our hospital. Imaging studies of both patients showed ARA stenosis. One patient had ARA occlusion well-compensated through tortuous collateral branches, achieving normal blood pressure by medical treatment alone. The other patient had ARA stenosis coexisted with main renal artery stenosis, and revascularization of both arteries led to a significant postoperative reduction in blood pressure. A literature review was conducted to summarize overall treatment strategies for ARA-related hypertension and clarify the relationship between ARA and hypertension. Recent research supported an association between ARA and hypertension. While medical therapy remains the first-line treatment for ARA-related hypertension, interventional procedures should be considered for patients whose blood pressure remains uncontrolled despite conservative management.
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Affiliation(s)
- Lin Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiyun Xie
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Deqiang Kong
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Rong Zeng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiao Di
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Leng Ni
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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Shi P, Tang J, Yin X. Association between second- and third-trimester maternal lipid profiles and adverse perinatal outcomes among women with GDM and non-GDM: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:318. [PMID: 37147564 PMCID: PMC10161404 DOI: 10.1186/s12884-023-05630-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Lipid metabolism disorder during pregnancy has been reported in women with gestational diabetes mellitus (GDM). However, controversy remains regarding the relationship between maternal changes in lipid profiles and perinatal outcomes. This study investigated the association between maternal lipid levels and adverse perinatal outcomes in women with GDM and non-GDM. METHODS In total, 1632 pregnant women with GDM and 9067 women with non-GDM who delivered between 2011-2021 were enrolled in this study. Serum samples were assayed for fasting total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels during the second and third trimesters of pregnancy. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were calculated via multivariable logistic regression analysis to determine the association of lipid levels with perinatal outcomes. RESULTS The serum TC, TG, LDL, and HDL levels in the third trimester were significantly higher than those in the second trimester (p < 0.001). Women with GDM had significantly higher levels of TC and TG in the second and third trimesters than those with non-GDM in the same trimesters, while HDL levels decreased in women with GDM (all p < 0.001). After adjusting for confounding factors by multivariate logistic regression, every mmol/L elevation in TG levels of women with GDM in second and third trimesters was associated with a higher risk of caesarean section (AOR = 1.241, 95% CI: 1.103-1.396, p < 0.001; AOR = 1.716, 95% CI: 1.556-1.921, p < 0.001), large for gestational age infants (LGA) (AOR = 1.419, 95% CI: 1.173-2.453, p = 0.001; AOR = 2.011, 95% CI: 1.673-2.735, p < 0.001), macrosomia (AOR = 1.220, 95% CI: 1.133-1.643, p = 0.005; AOR = 1.891, 95% CI: 1.322-2.519, p < 0.001), and neonatal unit admission (NUD; AOR = 1.781, 95% CI: 1.267-2.143, p < 0.001; AOR = 2.052, 95% CI: 1.811-2.432, p < 0.001) cesarean delivery (AOR = 1.423, 95% CI: 1.215-1.679, p < 0.001; AOR = 1.834, 95% CI: 1.453-2.019, p < 0.001), LGA (AOR = 1.593, 95% CI: 1.235-2.518, p = 0.004; AOR = 2.326, 95% CI: 1.728-2.914, p < 0.001), macrosomia (AOR = 1.346, 95% CI: 1.209-1.735, p = 0.006; AOR = 2.032, 95% CI: 1.503-2.627, p < 0.001), and neonatal unit admission (NUD) (AOR = 1.936, 95% CI: 1.453-2.546, p < 0.001; AOR = 1.993, 95% CI: 1.724-2.517, p < 0.001), which were higher than the relative risk of these perinatal outcomes in women with non-GDM. Additionally, every mmol/L increase in second and third-trimester HDL levels of women with GDM was associated with decreased risk of LGA(AOR = 0.421, 95% CI: 0.353-0.712, p = 0.007; AOR = 0.525, 95% CI: 0.319-0.832, p = 0.017) and NUD (AOR = 0.532, 95% CI: 0.327-0.773, p = 0.011; AOR = 0.319, 95% CI: 0.193-0.508, p < 0.001), and the risk reduction was not strong than that of women with GDM. CONCLUSIONS Among women with GDM, high maternal TG in the second and third trimesters was independently associated with an increased risk of cesarean section, LGA, macrosomia, and NUD. High maternal HDL during the second and third trimesters was significantly associated with decreased risk of LGA and NUD. These associations were stronger than those in women with non-GDM, suggesting the importance of monitoring second and third-trimester lipid profiles in improving clinical outcomes, especially in GDM pregnancies.
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Affiliation(s)
- Ping Shi
- Wujin Hospital Affiliated With Jiangsu University, Changzhou, Jiangsu, China
- The Wujin Clinical College of Xuzhou Medical University, No 2 Yongning North Road, Tianning District, Changzhou, Jiangsu, China
| | - Jie Tang
- Wujin Hospital Affiliated With Jiangsu University, Changzhou, Jiangsu, China
- The Wujin Clinical College of Xuzhou Medical University, No 2 Yongning North Road, Tianning District, Changzhou, Jiangsu, China
| | - Xiaoyan Yin
- Wujin Hospital Affiliated With Jiangsu University, Changzhou, Jiangsu, China.
- The Wujin Clinical College of Xuzhou Medical University, No 2 Yongning North Road, Tianning District, Changzhou, Jiangsu, China.
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-63860.186.92a54.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023; 11:1506-1512. [PMID: 36926389 PMCID: PMC10011986 DOI: 10.12998/wjcc.v11.i7.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/11/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia. Although accessory renal arteries are frequent, to date, only six cases of secondary hypertension determined by their existence have been reported. CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy. Despite normal renal arteries, the computed tomography angiography revealed an inferior polar artery with 50% stenosis of its diameter. Conservative treatment with amlodipine, indapamide and perindopril was adopted, leading to blood pressure control within one month. CONCLUSION To the best of our knowledge, there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension, but the seven similar cases already described, along with the current case, could reinforce the necessity of more studies concerning this subject.
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Affiliation(s)
- Amalia Calinoiu
- Department of Internal Medicine, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucuresti 011356, București, Romania
| | - Elena-Cristina Guluta
- Department of Gastroenterology, Bucharest University Emergency Hospital, Bucharest 050098, Romania
| | - Adina Rusu
- Department of Internal Medicine, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucuresti 011356, București, Romania
| | - Alexandra Minca
- Department of Internal Medicine Clinic, Bucharest University Emergency Hospital, Bucharest 050098, Romania
| | - Dragos Minca
- Department of Rheumatology Clinic, Center of Rheumatic Disease "Dr. Ion Stoia", Bucharest 030167, Romania
| | - Luminita Tomescu
- Department of Radiology Clinic, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Valeriu Gheorghita
- Department of Infectious Disease Clinic, Prof Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Dana Galieta Minca
- Department of Public Health and Management, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Lucian Negreanu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-3343.186.9f95e.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-127021.186.264be.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: ./10.12998/wjcc.v11.i7.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Maisons V, Le Jeune S, Barber-Chamoux N, Boudghene-Stambouli F, Brucker M, Delsart P, Lopez-Sublet M, Perez L, Radhouani I, Sosner P, Sautenet B. Relationship between accessory renal arteries and resistant hypertension: A cohort study. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:18-23. [PMID: 37120265 DOI: 10.1016/j.jdmv.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/20/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Resistant hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials have suggested a high prevalence of accessory renal arteries (ARA) in RHT. Our objective was to compare the prevalence of ARA in RHT vs. non-resistant hypertension (NRHT). METHODS Eighty-six patients with essential hypertension who benefited from an abdominal CT-scan or MRI during their initial workup were retrospectively recruited in 6 French ESH (European Society of Hypertension) centers. At the end of a follow-up period of at least 6 months, patients were classified between RHT or NRHT. RHT was defined as uncontrolled blood pressure despite the optimal doses of three antihypertensive agents of which one is a diuretic or similar, or controlled by ≥ 4 medications. Blinded independent central review of all radiologic renal artery charts was performed. RESULTS Baseline characteristics were: age 50±15 years, 62% males, BP 145±22/87±13mmHg. Fifty-three (62%) patients had RHT and 25 (29%) had at least one ARA. Prevalence of ARA was comparable between RHT (25%) and NRHT patients (33%, P=0.62), but there were more ARA per patient in NRHT (2±0.9) vs. RHT (1.3±0.5, P=0.05), and renin levels were higher in ARA group (51.6±41.7 mUI/L vs. 20.4±25.4 mUI/L, P=0.001). ARA were similar in diameter or length between the 2 groups. CONCLUSIONS In this retrospective series of 86 essential hypertension patients, we found no difference in the prevalence of ARA in RHT and NRHT. More comprehensive studies are needed to answer this question.
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Affiliation(s)
- Valentin Maisons
- Club des jeunes hypertensiologues, France; Service de néphrologie, CHU de Tours, Tours, France; Inserm U1246 SPHERE, université de Nantes, université de Tours, Tours, France.
| | - Sylvain Le Jeune
- Club des jeunes hypertensiologues, France; Service de médecine interne et vasculaire, CHU d'Avicenne, AP-HP, Bobigny, France.
| | - Nicolas Barber-Chamoux
- Club des jeunes hypertensiologues, France; Service de cardiologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Fanny Boudghene-Stambouli
- Club des jeunes hypertensiologues, France; Service de cardiologie, polyclinique Saint-Laurent, Rennes, France.
| | - Marie Brucker
- Club des jeunes hypertensiologues, France; Service de néphrologie, centre hospitalier de Valence, Valence, France.
| | - Pascal Delsart
- Club des jeunes hypertensiologues, France; Service de médecine vasculaire et HTA, CHU de Lille, Lille, France.
| | - Marilucy Lopez-Sublet
- Club des jeunes hypertensiologues, France; Service de médecine interne et vasculaire, CHU d'Avicenne, AP-HP, Bobigny, France; Inserm U942 MASCOT, université Paris Nord, Paris 13, France; FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
| | - Laurence Perez
- Club des jeunes hypertensiologues, France; Service de cardiologie, clinique d'Occitanie, Muret, France.
| | | | - Philippe Sosner
- Club des jeunes hypertensiologues, France; Mon Stade, maison sport-santé, Paris, France.
| | - Bénédicte Sautenet
- Club des jeunes hypertensiologues, France; Service de néphrologie, CHU de Tours, Tours, France; Inserm U1246 SPHERE, université de Nantes, université de Tours, Tours, France; FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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Correlation between Renal Artery Anatomy and Hypertension: A Retrospective Analysis of 3000 Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:9957361. [PMID: 35003315 PMCID: PMC8731270 DOI: 10.1155/2021/9957361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
Objective To assess the correlation between renal artery anatomy and blood pressure in Undiagnosed Hypertension and Diagnosed Hypertension. Methods The renal artery CT scanning imaging data and laboratory data of 3000 inpatients and outpatients were collected retrospectively in 4 centers of China. Morphometric parameters were assessed using the quantitative vascular analysis (unit: mM). Results 687 cases (23.2%) had accessory renal arteries unilaterally, and 216 cases (7.3%) had bilateral accessory renal arteries, including left kidney 825 (27.9%) and right kidney 798 (27.0%). The presence of accessory renal arteries and renal artery branches was higher in the diagnosed hypertension group as compared with the undiagnosed hypertension group (MARB, pp < 0.001; ARA, p < 0.001; others, p < 0.001). Consequently, multivariate regression analysis showed that age (OR = 2.519 (95% CI: 0.990–6.411, p < 0.001)), dyslipidemia (OR = 1.187 (95% CI: 0.960–1.454, p = 0.007)), renal hilum Outside the main renal artery branch (MRAB) (OR = 2.069 (95% CI: 1.614–2.524, p = 0.002)), and accessory renal artery (ARA) (OR = 2.071 (95% CI: 1.614–2.634, p = 0.001)) were risk factors of hypertension. In addition, higher renin activity was associated with ARA patients (2.19 ± 2.91 vs. 1.75 ± 2.85, p < 0.001). Conclusions When comparing renal arteries side by side, the anatomical length of the renal arteries is significantly different. In addition, the prevalence of accessory renal arteries and renal artery branches is higher in the hypertension group. The auxiliary renal artery and the main renal artery branch outside the renal portal are independent factors of hypertension. Renal sympathetic nerve activity is affected by renin activity and is related to the accessory renal artery.
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Relationship between Accessory Renal Artery and Clinical Characteristics of Middle-Aged Patients with Primary Hypertension. Int J Hypertens 2020; 2020:7109502. [PMID: 32328302 PMCID: PMC7171647 DOI: 10.1155/2020/7109502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/06/2020] [Indexed: 01/18/2023] Open
Abstract
Objectives The association between accessory renal artery (ARA) and hypertension remains not fully understood. We observed the association between ARA and clinical characteristics among middle-aged patients with primary hypertension. Methods One hundred and sixty-two middle-aged (mean 39.82 ± 10.25 years, 58.0% male) patients with primary hypertension were enrolled, and patients underwent Computed Tomography Angiography (CTA) of renal arteries, ambulatory blood pressure monitor (ABPM), echocardiography, physical examination, and routine blood chemistry examinations. According to the CTA results, patients were divided into a non-ARA (n = 108) and ARA (n = 54) group. Direct renin concentration (DRC), plasma aldosterone concentration (PAC), ABPM, echocardiography, creatinine, and glomerular filtration rate were compared between the two groups. Results DRC (mU/L) (11.21 (5.34, 20.87) vs. 18.24 (10.32, 33.59), P=0.002) was significantly higher in the ARA group than in the non-ARA group. However, PAC (ng/dL) (98.30 (67.30, 134.00) vs. 116.50 (78.80, 137.25), P=0.103) was similar between these two groups. ABPM (mmHg) results showed that daytime (146.75 ± 17.04/95.86 ± 11.39 vs. 155.50 ± 14.76/100.48 ± 10.69, P < 0.05), night time (133.44 ± 17.50/85.28 ± 12.80 vs. 139.81 ± 14.64/89.83 ± 11.21, P < 0.05), and 24 h blood pressure (143.95 ± 15.99/93.90 ± 11.78 vs. 152.07 ± 13.85/98.11 ± 10.36, P < 0.05) were significantly higher in the ARA group than in the non-ARA group. Accordingly, echocardiographic-derived posterior left ventricular wall thickness value was higher in the ARA group than in the non-ARA group. Conclusion ARA is related to higher blood pressure and higher direct renin concentration in middle-aged patients with primary hypertension, and these patients deserve stricter blood pressure control. Our results provide important evidence for that ARA is a cause of hypertension and target organs damages.
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Lauder L, Ewen S, Tzafriri AR, Edelman ER, Lüscher TF, Blankenstijn PJ, Dörr O, Schlaich M, Sharif F, Voskuil M, Zeller T, Ukena C, Scheller B, Böhm M, Mahfoud F. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension. EUROINTERVENTION 2019; 14:121-128. [PMID: 29633939 DOI: 10.4244/eij-d-18-00112] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS With increasing attention to renovascular causes and targets for hypertension there arises a critical need for more detailed knowledge of renal arterial anatomy. However, a standardised nomenclature is lacking. The present study sought to develop a standardised nomenclature for renal anatomy considering the complexity and variation of the renal arterial tree and to assess the applicability of the nomenclature. METHODS AND RESULTS One thousand hypertensive patients underwent invasive selective renal artery angiography in nine centres. Further, renovasography was performed in 249 healthy swine as a surrogate for normotensive anatomy. Anatomical parameters were assessed by quantitative vascular analysis. Patients' mean blood pressure was 168/90±26/17 mmHg. The right main renal artery was longer than the left (41±15 mm vs. 35±13 mm, p<0.001), but the left had a greater diameter (5.4±1.2 vs. 5.2±1.2 mm, p<0.001). Accessory renal arteries and renal artery disease were documented in 22% and 9% of the patients, respectively. Other than exhibiting a longer left main renal artery in uncontrolled hypertensives (+2.7 mm, p=0.034) there was no anatomical difference between patients with controlled and uncontrolled hypertension. Main renal artery mean diameter was smaller in patients with impaired kidney function (GFR <90 ml/min, left -0.5 mm, right -0.4 mm, both p<0.001). CONCLUSIONS Renal arterial anatomy differs between sides but shows no difference between patients with and without blood pressure control. Impaired GFR was associated with small main renal artery diameter.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg/Saar, Germany
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Chan PL, Tan FHS. Renin dependent hypertension caused by accessory renal arteries. Clin Hypertens 2018; 24:15. [PMID: 30410790 PMCID: PMC6211501 DOI: 10.1186/s40885-018-0100-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
Background Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism. Case presentation We report 2 cases of hypertension with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery. Conclusion Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes to hypertension in the patient as targeted treatment such as aldosterone antagonist can be initiated. Surgical intervention or renal denervation may be considered in resistant cases.
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Affiliation(s)
- Pei Lin Chan
- Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586 Kuching, Sarawak Malaysia
| | - Florence Hui Sieng Tan
- Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, 93586 Kuching, Sarawak Malaysia
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Lareyre F, Panthier F, Jean-Baptiste E, Hassen-Khodja R, Raffort J. Coverage of Accessory Renal Arteries During Endovascular Aortic Aneurysm Repair: What Are the Consequences and the Implications for Clinical Practice? Angiology 2018; 70:12-19. [DOI: 10.1177/0003319718771249] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An accessory renal artery (ARA) represents an anatomic variation which can challenge endovascular aortic aneurysm repair (EVAR). The aim of this review was to summarize the current knowledge on postoperative outcomes following ARA coverage during EVAR. We performed a systematic literature review. The MEDLINE database was searched on September 2017, and 8 relevant studies were included. The frequency of ARA in patients undergoing EVAR varied between 9.5% and 16.2%, and the frequency of ARA coverage varied between 5.2% and 9.4%. Four reports did not observe any significant changes on postoperative renal function, whereas 1 study reported an early transient increase in creatinine after ARA coverage. The occurrence of renal infarct varied from 20% to 84%. Five studies did not observe endoleaks related to ARA coverage, whereas one reported the occurrence of type II endoleaks in 3 of 18 patients who had ARA coverage. No significant change in blood pressure, mortality, and mean length of hospital stay was observed. The ARA coverage can potentially have renal and vascular consequences, but none of them were critical. Further studies may be useful to identify preoperative criteria that may help to choose the most appropriate surgical approach before ARA coverage.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Clinical Biochemistry, University of Côte d’Azur, Inserm, C3M, France
| | - Frédéric Panthier
- Department of Urology, Tenon University Hospital, University of Pierre et Marie Curie, Paris, France
| | - Elixène Jean-Baptiste
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Clinical Biochemistry, University of Côte d’Azur, Inserm, C3M, France
| | - Réda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Clinical Biochemistry, University of Côte d’Azur, Inserm, C3M, France
| | - Juliette Raffort
- Department of Clinical Biochemistry, University of Côte d’Azur, Inserm, C3M, France
- Department of Clinical Biochemistry, University Hospital of Nice, Nice, France
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Gulas E, Wysiadecki G, Szymański J, Majos A, Stefańczyk L, Topol M, Polguj M. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci 2018; 14:442-453. [PMID: 29593819 PMCID: PMC5868651 DOI: 10.5114/aoms.2015.55203] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 11/17/2022] Open
Abstract
Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.
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Affiliation(s)
- Ewelina Gulas
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Jacek Szymański
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Lodz, Poland
| | | | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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16
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Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension. Int J Cardiol 2015; 202:388-93. [PMID: 26432488 DOI: 10.1016/j.ijcard.2015.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/20/2015] [Accepted: 09/15/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Renal denervation (RDN) has been shown to reduce blood pressure (BP), muscle sympathetic nerve activity (MSNA) and target organ damage in patients with resistant hypertension (RH) and bilateral single renal arteries. The safety and efficacy of RDN in patients with multiple renal arteries remains unclear. METHODS We measured office and 24-hour BP at baseline, 3 and 6 months following RDN in 91 patients with RH, including 65 patients with single renal arteries bilaterally (group 1), 16 patients with dual renal arteries on either one or both sides (group 2) and 10 patients with other anatomical constellations or structural abnormalities (group 3). Thirty nine out of 91 patients completed MSNA at baseline and follow-up. RESULTS RDN significantly reduced office and daytime SBP in group 1 at both 3 and 6 months follow-up (P<0.001) but not in groups 2 and 3. Similarly, a significant reduction in resting baseline MSNA was only observed in group 1 (P<0.05). There was no deterioration in kidney function in any group. CONCLUSION While RDN can be performed safely irrespective of the underlying renal anatomy, the presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH. However, when patients with dual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction. Insufficient renal sympathetic nerve ablation may account for these differences.
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de Leon-Martinez EP, Garza JA, Azpiri-Lopez JR, Dillon KN, Salazar LO, Canepa-Campos F, Rousselle SD, Tellez A. Safety and Clinical Outcome of the Delivery of Radiofrequency Nerve Ablation Therapy in a Renal Artery of Unusual Anatomy. High Blood Press Cardiovasc Prev 2015; 22:445-8. [PMID: 26014838 DOI: 10.1007/s40292-015-0107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Catheter-based renal sympathetic denervation is an emerging therapy for resistant hypertension (RHTN) patients, resulting in a significant blood pressure reduction. The presence of accessory renal arteries and anomalous branching patterns are reported in approximately 20-27 % of patients. However, accessory renal arteries, when smaller than 4 mm in diameter, they are out of the inclusion criteria for renal denervation therapy. For this reason patients with evidence of accessory renal arteries have been excluded in previous clinical trials. Recent data suggest that accessory renal arteries may play an important role in non-response therapy when they do not receive renal denervation treatment. CASE REPORT In this report, we present the outcome of a patient with resistant hypertension and an anomalous right renal artery, having undergone denervation of both principal and accessory renal arteries. The renal ablation by radiofrequency energy of a distant accessory renal artery resulted in a safe procedure with no clinical complications. CONCLUSION Consistent with literature the RDN of all, main and accessory renal arteries, was effective in decreasing patient blood pressure while decreasing the need for antihypertensive medication.
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Affiliation(s)
| | - Javier A Garza
- Alizée Pathology, 20 Frederick Rd, Thurmont, MD, 21788, USA
| | | | | | | | | | | | - Armando Tellez
- Alizée Pathology, 20 Frederick Rd, Thurmont, MD, 21788, USA.
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18
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Anatomical Eligibility of the Renal Vasculature for Catheter-Based Renal Denervation in Hypertensive Patients. JACC Cardiovasc Interv 2014; 7:187-192. [DOI: 10.1016/j.jcin.2013.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/12/2013] [Accepted: 10/15/2013] [Indexed: 11/23/2022]
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Bertoldi L, Latib A, Piraino D, Regazzoli D, Sticchi A, Pizzetti G, Camici PG, Colombo A. Renal denervation in a patient with two renal accessory arteries: a case report. Blood Press 2013; 22:325-8. [PMID: 23547744 DOI: 10.3109/08037051.2013.778002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Percutaneous renal denervation has emerged as an effective adjunct in the management of resistant hypertension. However, the limits of the renal anatomical criteria that can be successfully treated are still unknown. In this report, we describe the case of a middle-aged man with essential resistant hypertension and two small left accessory renal arteries that underwent renal denervation of both principal renal arteries. He responded well with a progressive reduction in blood pressure measuring of 16/10, 32/17 and 45/24 mmHg at 1, 6 and 12 months, respectively. At 12 months, 94% of ambulatory measurements were below 140/90 mmHg and the number of anti-hypertensive medications had decreased from six to three. Thus, it would appear that the presence of two non-ablated left accessory renal arteries does not influence the response to renal denervation.
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Affiliation(s)
- Letizia Bertoldi
- Department of Cardio-Thoracic-Vascular Medicine, San Raffaele Scientific Institute , Milan , Italy
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Himmel F, Bode F, Mortensen K, Reppel M, Franzen K, Schunkert H, Weil J. Successful single-sided renal denervation approach in a patient with stenosis of an accessory renal artery. J Clin Hypertens (Greenwich) 2012; 14:187-8. [PMID: 22372780 PMCID: PMC8108947 DOI: 10.1111/j.1751-7176.2011.00585.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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22
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Gokalp G, Hakyemez B, Erdogan C. Vascular anomaly in bilateral ectopic kidney: a case report. CASES JOURNAL 2010; 3:5. [PMID: 20076808 PMCID: PMC2806859 DOI: 10.1186/1757-1626-3-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/05/2010] [Indexed: 11/10/2022]
Abstract
Ectopic kidney occurs as a result of a halt in migration of kidneys to their normal locations during embryonal period. While kidneys ascend through pelvis, they receive new branches from vessels (iliac and aorta) close to them. When they reach the highest point, they receive new branches from aorta and the former branches degenerate. Renal vessels do not degenerate in the ectopic caudal kidney, more than one accessory and polar arteries may arise. In various studies, a possibility of association between presence of multiple renal arteries and hypertension, has been reported. We aimed to present a case with bilateral ectopic kidney and vascular anomaly associated with hypertension and renal dysfunction.
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Affiliation(s)
- Gokhan Gokalp
- Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa, Turkey
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Kuczera P, Włoszczyńska E, Adamczak M, Pencak P, Chudek J, Wiecek A. Frequency of renal artery stenosis and variants of renal vascularization in hypertensive patients: analysis of 1550 angiographies in one centre. J Hum Hypertens 2009; 23:396-401. [PMID: 19129856 DOI: 10.1038/jhh.2008.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/09/2008] [Accepted: 11/14/2008] [Indexed: 11/08/2022]
Abstract
Renal artery stenosis (RAS) is an important cause of arterial hypertension and chronic kidney disease. The aims of our study were to assess the prevalence of RAS and to examine the frequency of variants of renal vasculature, that is, multiple and/or accessory renal arteries in hypertensive patients referred to renal angiography. We evaluated retrospectively 1554 arteriographies of hypertensive patients. Angiograms were evaluated to find RAS, significant RAS (>60% stenosis of the lumen), radiological signs of atherosclerosis, aneurysms of the renal arteries or aorta and variants of kidney vascularization. The frequency of RAS including occlusions was 15.1% (21.3% of them were significant and suitable for revascularization). Variants of renal arterial vascularization were found in 26.5% of patients (multiple renal arteries-11.2% and accessory renal arteries-15.3%). Significant RAS was found more frequently in patients older than 60 years-OR 4.76 (2.08-10.86). Coronary artery disease, history of myocardial infarction or stroke significantly increased the chance of RAS detection. The frequency of renal accessory arteries was lower in patients older than 60 years and in patients with the radiological signs of atherosclerosis. Results of this study indicate that haemodynamically important RAS is found more frequently in hypertensive patients older than 60 years. Symptomatic atherosclerotic disease found in the peripheral and/or coronary arteries and diabetes mellitus increases the chance of RAS detection. Decreased occurrence of renal accessory arteries was found in hypertensive patients with radiological signs of atherosclerosis.
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Affiliation(s)
- P Kuczera
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
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Maceira AM, Prasad SK, Pennell DJ, Mohiaddin RH. Integrated evaluation of hypertensive patients with cardiovascular magnetic resonance. Int J Cardiol 2008; 125:383-90. [PMID: 17475351 DOI: 10.1016/j.ijcard.2007.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 12/26/2006] [Accepted: 03/25/2007] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypertension causes cardiac morbidity and premature mortality. Accurate evaluation to exclude potentially curable causes is important. Cardiovascular Magnetic Resonance and Magnetic Resonance Angiography (CMR/CE-MRA) provide an integrated approach to the assessment of hypertensive patients - a single study can identify certain secondary causes and assess left ventricular (LV) mass and function. The aim of this study was to prospectively evaluate the feasibility of CMR/CE-MRA to define LV dimensions and exclude some secondary causes in a selected group of hypertensives. METHODS AND RESULTS Fifty-three hypertensives (46+/-17 years, 18 females) were prospectively studied (early onset hypertension, n=17; drug resistant hypertension, n=23; hypertension with increased creatinine at baseline/after ACEi, n=12; hypertension with peripheral vessel disease, n=1). Study protocol included assessment of LV and aorta, imaging of adrenals and 3D CE-MRA of aorta and renal arteries. Significant abnormalities were found in 13 patients (25%) - renal artery stenosis (n=8), aortic coarctation (n=4), adrenal mass (n=1). Mean LV mass index was increased compared with matched controls. LV systolic dysfunction was found in 9 patients. CONCLUSIONS CMR/CE-MRA provides comprehensive evaluation of hypertensive patients and could allow for a unique integrated approach with assessment of LV dimensions as well as detection of some secondary causes.
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Affiliation(s)
- Alicia M Maceira
- Magnetic Resonance Unit, ERESA-Hospital Arnau de Vilanova, Valencia, Spain
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Michaely H, Reichert M, Weckbach S, Schoenberg S. Vaskuläre und parenchymale Erkrankungen der Nieren. Radiologe 2008; 48:185-200; quiz 201-2. [DOI: 10.1007/s00117-008-1616-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Karmacharya J, Parmer SS, Antezana JN, Fairman RM, Woo EY, Velazquez OC, Golden MA, Carpenter JP. Outcomes of accessory renal artery occlusion during endovascular aneurysm repair. J Vasc Surg 2006; 43:8-13. [PMID: 16414380 DOI: 10.1016/j.jvs.2005.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2005] [Accepted: 09/03/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Accessory renal arteries are frequently encountered when patients are evaluated for endovascular abdominal aortic aneurysm repair (EVAR). Some have considered their presence a contraindication to EVAR in fear of endoleak and the end result of renal function. We sought to determine whether the coverage of accessory renal arteries during EVAR was associated with any adverse sequelae. METHODS Retrospective review of the medical records and computed tomographic scans of all patients undergoing EVAR (1998 to 2003) was performed. Note was made of the presence or absence of accessory renal arteries, hypertension, and renal function. Preoperative computed tomographic images were compared with postoperative images to determine the presence of renal infarction. A control group of 26 consecutive patients without accessory renal arteries was used for comparison of the results of EVAR. RESULTS EVAR was performed in 550 patients over the study interval. The mean follow-up was 16 months (range, 1-48 months). The average age was 74 years (range, 57-90 years). Thirty-five patients (6.6%; 32 male and 3 female) were documented to have accessory renal arteries; the average number of accessory arteries was 2 (range, 1-4). Bilateral accessory arteries were present in 13 patients: all but 1 patient (n = 34) had a left-sided accessory renal artery, and 23 had a right-sided accessory renal artery. EVAR was performed with a variety of endografts: AneuRx (n = 10), Talent (n = 7), PowerLink (n = 7), Zenith (n = 5), LifePath (n = 4), and Ancure (n = 2). There were no mortalities. Twelve endoleaks were documented: three type I, eight type II, and one type III. The accessory renal arteries were not implicated in any of the endoleaks, and none of these accessory vessels was embolized before or after EVAR. Seven patients (20%) had renal infarcts associated with EVAR that were noted on follow-up computed tomographic scans. The mean follow-up for patients with segmental infarction was 23 months (range, 8-48 months). Hypertensive status did not change in any patient in whom an accessory renal artery had been covered. The average serum creatinine was 1.08 mg/dL (range, 0.6-1.8 mg/dL) before EVAR in patients with accessory renal arteries covered by an endovascular graft and did not change significantly in response to EVAR. Serum creatinine increased almost twofold in two patients but spontaneously resolved in follow-up. The average preoperative creatinine clearance was 79 mL/min (range, 35-166 mL/min) in patients without an accessory renal artery and was 80 mL/min (range, 35-167 mL/min) after EVAR. The average preoperative creatinine clearance was 67 mL/min (range, 31-137 mL/min) in patients with an accessory renal artery and 68 mL/min (range, 45-83 mL/min) in patients with renal infarcts. None of the patients required temporary or permanent dialysis. There was no difference between control patients and patients with covered accessory renal arteries with respect to hypertensive status, presence of renal infarcts, serum creatinine, or creatinine clearance after EVAR. CONCLUSIONS Occlusion of accessory renal arteries is not associated with clinically significant signs or symptoms, even in patients with mild or moderate renal insufficiency. Sacrifice of accessory renal arteries most commonly does not lead to detectable renal infarction, either clinically or radiographically. When segmental infarction of the kidney does result, it seems to be well tolerated in this group of patients. Accessory renal arteries were not found to contribute to endoleaks and should not be prophylactically embolized.
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D.C. K, D.F. L, J. W, D. H, X Y. Accessory Renal Arteries—Mostly, But Not Always, Innocuous. J Am Soc Nephrol 2005. [DOI: 10.1681/asn.2005101131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Priestman WS, DeNunzio M, Taal MW, Fluck RJ, McIntyre CW. An unusual case of renovascular hypertension-renal artery stenosis of a pelvic kidney with aberrant blood supply. Nephrol Dial Transplant 2005; 20:2861-3. [PMID: 16204291 DOI: 10.1093/ndt/gfi148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- William S Priestman
- Department of Renal Medicine, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
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Michaely HJ, Schoenberg SO, Rieger JR, Reiser MF. MR Angiography in Patients with Renal Disease. Magn Reson Imaging Clin N Am 2005; 13:131-51, vi. [PMID: 15760760 DOI: 10.1016/j.mric.2004.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Henrik J Michaely
- Department of Clinical Radiology, University Hospitals, Ludwig Maximilians University-Munich, Grosshadern Marchioninistrasse 15, Munich 81377, Germany.
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