Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient / Revascularização endovascular simultânea de dissecção da artéria ilíaca externa e de estenose da artéria renal transplantada em receptor recente de aloenxerto renal

Abstract Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.

Resumo As diversas complicações vasculares possíveis após um transplante renal incluem trombose da veia e artéria renais, estenose da artéria renal, pseudoaneurisma e dissecção da artéria ilíaca. Entre essas diversas complicações, a estenose da artéria renal transplantada é a mais comum, enquanto a dissecção da artéria ilíaca é a mais rara. Relatamos o caso de um homem idoso que desenvolveu tanto dissecção da artéria ilíaca quanto estenose da artéria renal transplantada 2 meses após transplante renal. As intervenções endovasculares percutâneas foram bem-sucedidas em ambas as complicações. O período pós-intervenção cursou sem complicações, com melhora na função renal do enxerto e na perfusão do membro inferior esquerdo.

Study on therapeutic effect and its related mechanism of anemoside B4 on ischemia reperfusion injury induced by renal artery and vein ligation in rats / 中国中药杂志

The aim of this paper was to investigate the effect and mechanism of anemoside B4 on renal ischemia reperfusion injury in rats. A total of 50 rats were randomly divided into the model group(NS) and anemoside B4 low-dose(1.25 mg·kg~(-1)), medium-dose(2.5 mg·kg~(-1)) and high-dose(5 mg·kg~(-1)) groups after the right kidney was removed and the left kidney was ligated to make the ischemia reperfusion model. Another 10 rats were selected as sham operation group only for normal control group(NS, received normal saline). Automatic biochemical analyzer was used to measure serum blood urea nitrogen(BUN), creatinine(Cre), cerebrospinal fluid(CSF) and urinemicroalbumin(mALB) levels after 5 days of tail vein injection treament. Total urine protein and total urinary albu-min were calculated and kidney samples were collected. Histopathological changes of renal tissues were observed by PAS staining. Western blot analysis was performed to detect the protein expressions of TLR4 and NF-κB in renal inflammatory factors related to NLRP3 pathway and TLR4/NF-κB pathway. The results showed that the levels of BUN, Cre, urinary total protein and urinary total albumin in the model group were significantly increased(P<0.01), with severe renal tubule injury was serious, manifested by obvious expansion of renal tubules, more serious tubular proteins, and some tubular epithelial cells were exfoliated. At the same time, the expression of inflammatory factors related to NLRP3 pathway and TLR4/NF-κB pathway increased significantly(P<0.01 or P<0.05). The levels of BUN, Cre were reduced in different doses of anemoside B4(P<0.05). The levels of total urinary protein and total urinary albumin were decreased in the low and high dose groups of anemoside B4.The level of total urinary albumin in the high-dose group of anemoside B4 was significantly reduced(P<0.05).Renal tubular injury was alleviated, tubular epithelial cell exfoliation was reduced, and the expression of related inflammatory factors was reduced in different degrees(P<0.01 or P<0.05). This study showed that anemoside B4 could alleviate renal ischemia-reperfusion injury in rats. And its mechanism may be related to the inhibition of inflammatory factors related to response mediated by NLRP3 pathway and TLR4/NF-κB pathway by anemoside B4.

Trombosis vascular en injerto renal visualizado en renograma con 99mtc - mag3, un evento infrecuente / Vascular thrombosis in renal graft visualized in 99mtc- mag3 renogram, in unfortunate event / Trombose vascular do enxerto em renal renogram exibido em 99m - mag3, um evento pouco freqüente

El trasplante renal es el tratamiento de elección para la enfermedad renal terminal. Pueden presentarse diversas complicaciones médicas y quirúrgicas posteriores, entre ellas las vasculares (trombosis/estenosis de la vena y/o arteria renal) que son poco frecuentes y resultan en la pérdida del injerto. Presentamos el caso de un paciente masculino que al tercer día posterior al trasplante persisten con anuria y elevación de azoados, realizándose renograma con 99m - Tc MAG3 con hallazgos compatibles de trombosis vascular.

Kidney transplantation is the treatment of choice for end-stage renal disease. Various medical and surgical complications can occur later, among them the vascular ones (thrombosis/stenosis of the vein and/or renal artery) that are infrequent and result in the loss of the graft. We present the case of a male patient who persisted with anuria and azoate elevation on the third day after transplantation, performing a renogram with 99m - Tc MAG3 with compatible findings of vascular thrombosis.

Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle

ABSTRACT Purpose This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. Methods Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. Results there is a correlation between the occurrence of renal damage as a function of time (p <0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. Conclusion the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.

Congenital renal arteriovenous fistula complicated with multiple renal arteries malformation: case analysis / 北京大学学报(医学版)

Congenital renal arteriovenous fistula complicated with multiple renal arteries malformation is rare and hard to diagnose at early stage. Blood loss and complications after embolization are both severe. Some cases can be diagnosed by ultrasound, enhanced CT scan or digital subtraction angiography (DSA). Cystoscopy and ureteroscopy can identify the location of bleeding, exclude tumors, and discharge ureteral obstruction. A case of congenital renal arteriovenous fistula complicated with multiple renal arteries malformation was reported to investigate the pathogenesis, clinical characteristics, diagnosis and treatment of congenital renal arteriovenous fistula with multiple renal arteries malformation. A 36-year-old female patient with congenital renal arteriovenous fistula with multiple renal arteries malformation was hospitalized in the Department of Urology of Peking University People's Hospital. Five days before admission, the patient experienced whole course painless gross hematuria for 5 days with many blood clots. The patient's blood pressure was 90/70 mmHg, and hemoglobin was 60 g/L. The urinary CT scan showed a right hydronephrosis associated with dilatation of the upper ureter which was obstructed by space occupying lesion of the lower ureter. Many clots in the bladder could also be found in the CT scan. Cystoscopy showed many blood clots in the bladder and confirmed that the bleeding was fromthe right ureteral orifice. Ureteroscopy confirmed that the bleeding was from the right renal pelvis and many blood clots in the right ureter, and found no tumor in the right ureter and renal pelvis. We cleared the blood clots in the right ureter and inserted a ureteral stent.We thought that renal vascular malformation of the right kidney might lead to the hematuria from right renal pelvis. DSA showed a double renal arteries malformation in the right kidney. The diagnosis of "renal arteriovenous fistula" was considered with renal arteriovenous fistula in the right kidney. Selective arteriography revealed the presence of tortuous, coiled, dilated, and multichannelled vessels in the middle of the right kidney. With stainless steel coils, we embolized the vessels which supplied the fistula. Four days after the procedure, gross hematuria disappeared. Five days after the procedure, the patient's anemia improvedand the patient was discharged in good condition. Four months after the procedure, gross hematuria did not recur. The Doppler showed that the right kidney was normal and the renal dynamic showed that the right kidney function was normal. So DSA is the golden standard for diagnosis of congenital renal arteriovenous fistula complicated with multiple renal arteries malformation. Confirming the number of renal arteries by abdominal aorta angiography is necessary to avoid missed diagnosis. Renal arterial embolization is safe and effective.

Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria

To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.

Evaluation of Arterial Impairment after Experimental Gelatin Sponge Embolization in a Rabbit Renal Model

OBJECTIVE: Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. MATERIALS AND METHODS: A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. RESULTS: Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. CONCLUSION: Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

Collared Pecary (tayassu tajacu) as a new model of renal ischemic injury induced by clamping the renal artery

PURPOSE: The use of the collared peccary as an experimental model for ischemic nephropathy. METHODS: A total of 12 collared peccary (Tayassu tajacu) was used and ischemic nephropathy was induced in six of these animals that constituted the experimental group (G1) while the other six formed the control group (G2). Ischemic nephropathy was induced surgically by partial occlusion of the left renal artery. The disease course was assessed by hematological tests, serum chemistry, urinalysis, ultrasound (US) and doppler ultrasound function of the renal artery before induction, and at five, 10, 15 and 20 days after surgery. Twenty days after the occlusion, unilateral nephrectomy and histopathological examination were performed to assess renal morphology. RESULTS: Statistical analysis by Fischer's test showed a significant difference (p<0.05) between the control group and the experimental group. The histopathological examination showed glomerular, tubular and interstitial lesions. In the experimental group, 83.3% (5 /6) showed moderate renal lesions and only 16.7% (1/6) were classified with no lesions. The ultrasound examination of the right kidney presented statistical difference between day 5 and day 10 post occlusion. CONCLUSION: The collared peccary as a good experimental model for ischemic renal disease, because it could be manipulated during the research time without death, with health conditions that permit any subsequent procedure for disease therapy. .

Proposta de correção virtual geométrica da projeção ostial da artéria renal no estudo operatório de aneurismas infrarrenais: resultados iniciais de um estudo piloto / Proposal of renal artery's ostial projection under virtual geometric correction in infrarenal aneurysms: initial results of a pilot study

Introdução: Para o preparo pré-operatório endovascular dos aneurismas infrarrenais é necessária a mensuração acurada de suas características anatômicas e morfológicas, alcançada com o uso de softwares avançados em manipulação de imagens de tomografias multicanais. Este processo permite também o estudo acurado das relações anatômicas das demais artérias do eixo aorto-ilíaco. Uma visualização perpendicular à origem da artéria renal mais baixa possibilita o uso de toda a extensão do colo para fixação da endoprótese e selamento proximal, o que pode ser previsto durante o estudo da tomografia, impedindo um posicionamento subótimo e a sobreposição das estruturas vasculares no intraoperatório. Expõem-se aqui os resultados iniciais de um projeto piloto, envolvendo manipulação de imagens tomográficas, na correção ortogonal da artéria renal aplicada à orientação radioscópica no intraoperatório. Métodos: Por meio de reconstrução multiplanar de imagens tomográficas em software obtém-se um corte axial em ângulo reto. Conceitos geométricos de triangulação virtual promovem a correção ortogonal em três dimensões da visualização ostial da artéria renal, que pode ser reproduzida intraoperatoriamente, através do reposicionamento do arco cirúrgico. Resultados/Discussão: Embora alguns autores argumentem que a anatomia do vaso observada na tomografia possa mudar durante o intraoperatório, sabe-se que o posicionamento angular das artérias renais não se modifica, mesmo após a inserção dos fios guia rígidos, introdutores e da própria endoprótese. Assim, acreditamos ser possível, por meio de ...

Introduction: Endovascular aneurysm repair requires the precise deployment of the graft. In order to achieve accurate positioning, the anatomical and morphological characteristics of the aorta and its branches is mandatory. Software that perform three dimensional reformatting of multislice tomographic images, allow for the study of the whole aorto-iliac axis and the perpendicular visualization of the origin of the renal arteries. The correct length of the proximal neck can be evaluated and adequate graft fixation and sealing may be foreseen. A technique is presented, using an software, for the orthogonal correction of the position of the renal arteries in relation to the proximal neck, which may guide the radioscopic orientation intraoperatively. Methods: Within a multiplanar tomographic image reconstruction, virtual triangulation allows for the three dimensional orthogonal correction of the renal arteries' ostia position. The predetermined best angulations for visualization are annotated and used for the positioning of the surgical C-arm. Results/Discussion: Some authors discuss that the anatomic position of the renal vessels seen on the tomographic scan can change during the surgical procedure. It is known that the renal arterys' angular positioning does not alter, even after insertion of stiff guidewires, introducers, and the endograft itself. Therefore, it is possible, using concepts of spacial geometry and orthogonal correction, to predict the ideal bidimensional intraoperative positioning of the radioscopy device in order to reproduce the optimized renal artery ostial projection, ensuring the best accuracy during endograft deployment. Conclusion: As closer to the tomographic reproduction was the radioscopic correction, more careful is the visualization of the ostium of the renal artery, better is the exploitation of the lap for fixing and sealing and the endoprosthesis deployment is more accurate. .

Aneurisma y fístula arterio-venosa renal: manejo quirúrgico laparoscópico asistido por robot / Renal artery aneurysm: robotic resolution

Introduction: Renal artery aneurysm is uncommon conditions, presenting a therapeutic challenge. Aim: To report a case of a complex intrarenal aneurysm associated with a arterio-venous fistula high flow, treated by robotic assistance. Case report: A 51 year-old man, with a long history of hypertension, was diagnosed of a complex intrarenal aneurysm, in routine radiological follow-up. Endovascular treatment was no possible due to an associated high flow arterio-venous, so robotic surgery was performed. The tributary arterial branch was dissected at the renal pedicle, and ligated easily. The radiological follow-up showed a complete resolution and normal renal function. Conclusion: This case, of low frequency, illustrates a successfully manner of resolution of a complex renal vascular pathology...

Introducción: Los aneurismas de la arteria renal constituyen una patología infrecuente, y plantean dificultades en la decisión terapéutica. Objetivo: Presentar un caso de un aneurisma complejo intrarenal, asociado a una fístula arterio-venosa de alto flujo, el cual fue resuelto con asistencia robótica. Caso clínico: Paciente de 51 años, con historia prolongada de hipertensión arterial, al cual, en estudio radiológico de rutina, se le diagnostica 3 aneurismas intrarenales derechos, asociado a una fístula arterio-venosa de alto flujo. Dada la imposibilidad de realizar tratamiento endovascular, se realiza cirugía robótica. Se diseca el hilio renal y se identifica la rama arterial tributaria del aneurisma, la cual se liga sin problemas. El control alejado demuestra resolución de la malformación, con mantención de la función renal. Conclusión: Este caso, de baja frecuencia, ilustra una forma de resolución de una patología vascular renal, con éxito...

Ablação da atividade simpática renal com cateter de ponta irrigada: uma opção atraente? / Renal sympathetic ablation using an irrigated-tip catheter: an attractive option?

INTRODUÇÃO: A denervação simpática renal por meio de cateteres surgiu como estratégia adjunta para o controle da hipertensão arterial resistente. Nenhum estudo até o momento comparou os efeitos teciduais de diferentes cateteres, potências e tempos de aplicação da radiofrequência, objetivo do presente estudo. MÉTODOS: Seis artérias renais de porco foram seccionadas em seu eixo longitudinal e colocadas em uma câmara projetada para simular condições fisiológicas de fluxo renal. Os cateteres foram posicionados obliquamente à artéria, mantendo-se pressão de contato constante. Aplicações de radiofrequência foram realizadas utilizando-se três diferentes dispositivos: eletrodo de ponta sólida 4 mm/5 F, eletrodo de ponta sólida 4 mm/7 F, e eletrodo com ponta aberta irrigada 4 mm/7 F. Duas energias foram aplicadas (8 W e 15 W), durante 30 segundos, 60 segundos e 120 segundos. RESULTADOS: No total foram realizadas 18 aplicações. Injúria neural renal mais significativa foi observada utilizando-se cateter 4 mm/5 F e energia de 8 W apenas quando a duração da aplicação foi estendida a 120 segundos. Por outro lado, significante dano neural foi observado com o cateter 4 mm/7 F com todas as potências (8 W e 15 W) e durações testadas (30 segundos, 60 segundos e 120 segundos). Lesões mais profundas foram notadas quando o cateter irrigado foi utilizado, independentemente da potência e da duração da aplicação. CONCLUSÕES: O cateter com ponta irrigada produz lesões mais profundas que os cateteres de ponta sólida e seu uso pode ser mais vantajoso na denervação simpática renal. A aplicabilidade clínica desses resultados, entretanto, deve ser confirmada.

BACKGROUND: Catheter-based renal sympathetic denervation has emerged as an adjunct strategy to control refractory hypertension. No studies have yet compared the tissue effects of different catheters, powers and time periods of radiofrequency application, which was the objective of this study. METHODS: Six porcine renal arteries were sectioned in their longitudinal axis and placed in the flow chamber designed to simulate physiological renal flow conditions. The catheters were placed obliquely to the artery with constant contact pressure. Radiofrequency ablations were performed using three different catheters: 4 mm/5 F solid-tip electrode, 4 mm/7 F solid-tip electrode, and open irrigated-tip 4 mm/7 F electrode. Two different powers were used (8 W and 15 W) for 30, 60 and 120 seconds. RESULTS: A total of 18 ablations were performed. More significant nerve damage was observed with the 4 mm/5 F catheter and power of 8 W only when the application duration was extended to 120 seconds. On the other hand, significant nerve damage was observed with the 4 mm/7 F catheter with all power (8 W and 15 W) and duration (30, 60, and 120 seconds) options tested. Deeper lesions were observed with the use of the irrigated catheter, regardless of power and time periods of radiofrequency application. CONCLUSIONS: The irrigated-tip catheters produce deeper lesions than solid-tip catheters and their use might be more beneficial in treating patients with renal sympathetic denervation. The clinical applicability of these results, however, should be confirmed.

Use of Drug-Eluting Stent with Provisional T-Stenting Technique in the Treatment of Renal Artery Bifurcation Stenosis; Long-term Angiographic Follow-up

Atherosclerotic renal artery stenosis (RAS) usually involves the ostium and the proximal one-third of the renal artery main branch. Percutaneous renal artery angioplasty with stent placement is a well recognized treatment for atherosclerotic RAS. Occasionally, atherosclerotic RAS involves renal artery bifurcations. However, stent implantation in atherosclerotic RAS involving bifurcation is not only troublesome, but also challenging because of side branch occlusion and in-stent restenosis (ISR). In the present report, we describe the use of drug-eluting stents (DES) with provisional T-stenting technique for the treatment of renal artery bifurcation lesion. Follow-up angiogram showed no significant ISR 18 months after the procedure. In the treatment of renal bifurcation lesions, a two-stent strategy using DES could be a viable option in selected patients.

Effect of renal embolization with trisacryl and PAVc

OBJECTIVES: Evaluate the degree of vascular occlusion, vascular recanalization, and necrosis of the vascular wall caused by polyvinyl alcohol-covered polyvinyl acetate (PVAc) particles compared to trisacryl particles after renal embolization. METHODS: Seventy-nine female albino New Zealand rabbits underwent arterial catheterization of the right kidney. Thirty-three animals were embolized with trisacryl particles, thirty-one with PVAc particles, and fifteen were kept as controls. Four animals were excluded (three trisacryl and one PVAc) due to early death. Five subgroups of six animals were created. The animals in the different groups were sacrificed either 48 hours, 5 days, 10 days, 30 days, or 90 days after embolization. The control group was divided into subgroups of three animals each and kept for the same periods of time. The kidneys were dyed with hematoxylin-eosin and Masson's trichrome and then examined using optical microscopy. RESULTS: There were significant differences in the degree of vascular occlusion caused by the trisacryl and the PVAc particles between the five-day and the ten-day groups. Additional differences were noted between the five-day and 48-hour groups in regard to the amount of necrosis. For both findings, the PVAc group members showed adequate tissue reaction (ischemia and volumetric reduction) and less recanalization than those treated with trisacryl. CONCLUSION: The use of PVAc as an embolization material exhibited an adequate tissue reaction (ischemia and volumetric reduction), more expressive vascular occlusion and necrosis, and less recanalization than the trisacryl material.

O stent descoberto não promove reações em artérias renais e parênquima renal em suínos / Uncovered stent does not provoke reactions in renal arteries and renal parenchyma in swines

OBJETIVO: Avaliar as alterações histológicas da aorta, artéria renal e parênquima renal, em suínos, induzidos pelo stent metálico descoberto implantado em localização transrenal na aorta abdominal. MÉTODOS: Foram utilizados 10 suínos com peso médio de 86,6 quilos e idade média de 6 meses, submetidos a implante de stent metálico posicionado na aorta, no nível das artérias renais, após 100 dias do implante. Os stents foram liberados por auto-expansão com laparotomia. Foram realizadas análises anatômicas e histológicas da aorta abdominal, artérias renais e parênquima renal. Os cortes histológicos foram realizados nos seguintes locais: 1) transição entre a aorta normal e aorta contendo stent; 2) porção contendo os óstios das artérias renais, 3) parênquima renal. As lâminas foram coradas pela técnica da hematoxilina e eosina e analisadas conforme protocolo de análise histológica aplicada na prática clínica dos laboratórios de patologia. RESULTADOS: Os achados macroscópicos revelaram espessamento da parede aórtica; artérias renais pérvias; estrutura anatômica renal normal. Análises microscópicas, próximas aos stents, evidenciaram espessamento da parede vascular, artérias renais sem alterações e parênquima renal preservado. CONCLUSÃO: O stent de aço inoxidável descoberto produziu importante reação inflamatória com espessamento da parede da aorta. No entanto, as artérias renais permaneceram pérvias e o parênquima renal sem alterações isquêmicas ou embólicas.

OBJECTIVE: To assess the histological changes of the aorta, the renal arteries and the renal parenchyma in swine, induced by a metalic uncovered stent implanted in transrenal position in the abdominal aorta. METHODS: Ten pigs with a mean weight of 86.6 kg and mean age of 6 months underwent implantation of metal stent graft placed in the aorta at the level of the renal arteries after 100 days of implantation. The self-expanding stents were released by laparotomy. Anatomic and histological analyses of the abdominal aorta, the renal arteries and the renal parenchyma were performed. Histological slices were performed in the following sites: 1) transitional zone between the aorta with and without stent graft; 2) portion of the renal arteries ostia; 3) renal parenchyma. The slices were stained through the hematoxylin and eosin stain technique and analyzed according the protocol of histological analyses applied in the clinical practice of pathology labs. RESULTS: The macroscopic findings showed thickening of the aortic wall; patent renal arteries; and normal anatomic renal structures. Microscopic analyses, close to the stents, showed thickening of the vascular wall, renal arteries without changes, and preserved renal parenchyma. CONCLUSION: The uncovered stainless steel stent caused a significant inflammatory reaction with thickening of the aortic wall. However, the renal arteries remained patent and the renal parenchyma did not present embolic or ischemic changes.

Renal infarction resulting from traumatic renal artery dissection

Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

[Ruptured aneurysm of the renal artery: case report and review of the literature]

The authors report the first case in Ivory Coast of a ruptured aneurysm of the renal artery in a 23-year-old man admitted for massive hematuria and shock. He was subjected to emergency midline laparotomy which showed that the kidney and the aneurysm were not easily accessible due to fibrosis and a large mass of blood clots. Total nephrectomy was performed. Follow-up after 3 months was uneventful. Based on this case, the authors review the literature concerning the epidemiology, classification, clinical features and management of aneurysms of the renal artery

Pseudoaneurisma arteria renal postnefrectomía parcial: Tratamiento exitoso con embolización selectiva / Renal artery pseudo aneurism after partial nephrectomy: Report of one case successfully treated with selective embolization

La cirugía renal conservadora ha llegado a ser el estándar en el tratamiento de lesiones tumorales renales de menos de 4 cm. El pseudoaneurisma de la arteria renal es una complicación rara de la nefrectomía parcial, sin embargo puede ser un cuadro grave y de difícil diagnóstico si no se tiene un alto índice de sospecha. El manejo dependerá de las condiciones del paciente, pudiendo llegar incluso a la nefrectomía de necesidad. A continuación presentamos un caso clínico de pseudoaneurisma post nefrectomía parcial manejado en forma exitosa con embolización selectiva.

Renal artery pseudo aneurism is an uncommon, severe and difficult to diagnose complication of partial nephrectomy. We report a 72 years old male subjected to a partial left nephrectomy to excise a 6 cm. diameter tumor. The patient was discharged four days after surgery, but was admitted again due to persistent hematuria. An ultrasound showed a cystic lesion in the kidney and clots in the ureter. A selective renal angiography showed a 4 cm diameter pseudo aneurism of the renal artery and a high flow arteriovenous fistula. Afferent branches were embolized and the fistula was completely occluded. A double catheter was installed in the ureter to resolve a hydronephrosis and the patient was discharged without symptoms, four days after admission.