Infrarenal aortic diameter, aortoiliac bifurcation level and lumbar disc degenerative changes: a cross-sectional MR study.

PURPOSE: To examine a possible correlation of infrarenal aortic diameter and aortoiliac bifurcation level with lumbar disc degenerative changes. METHODS: This was a cross-sectional, single-center retrospective study on lumbar magnetic resonance images of patients with low back pain (n = 496). Lumbar disc degenerative changes were reported on the basis of the Pfirrmann grading system and accordingly, patients were grouped as with grade I-II findings (n = 192), with grade III findings (n = 64) and with grade IV-V findings (n = 240). The groups were matched for sex, body mass index and the history of diabetes mellitus, hypertension, hyperlipidemia and smoking. Infrarenal aortic diameter and aortoiliac bifurcation level were compared between the three groups. RESULTS: Pairwise comparisons between the three groups of patients with Pfirrmann grades of I-II, III and IV-V revealed significant differences (p < 0.05) in terms of the median infrarenal aortic diameter (17 mm [interquartile range 4], 18 mm [4] and 19 mm [4], respectively) and the median aortoiliac bifurcation level (3 [2], 4 [2] and 5 [3], respectively; the higher the value, the more the caudal displacement). These associations were independent of conventional risk factors of atherosclerosis (including age) and from each other. CONCLUSIONS: This study showed a significant, direct correlation of the infrarenal aortic diameter and the level of aortoiliac bifurcation with lumbar intervertebral degenerative changes according to the Pfirrmann grading system. The associations were independent of well-known risk factors of atherosclerosis and from each other.

Vascular Doppler ultrasonographic indices in cirrhosis: a case-control study with emphasis on the common carotid arteries.

PURPOSE: To compare vascular Doppler waveform indices, particularly in the common carotid arteries, between cirrhotic and healthy subjects. MATERIALS AND METHODS: A total of 60 patients with Class-B cirrhosis and 60 healthy matched counterparts were enrolled in this prospective study. Vascular Doppler waveform parameters including resistance and/or pulsatility indices (RI and PI, respectively) were obtained from the common carotid, renal, celiac, superior mesenteric, femoral and brachial arteries. RESULTS: Compared to patients, healthy subjects had significantly higher mean PI and RI obtained from the common carotid (1.53 ± 0.20 vs. 1.43 ± 0.14, p = 0.03; 0.75 ± 0.02 vs. 0.72 ± 0.02, p < 0.001, respectively) and celiac arteries (2.00 ± 0.36 vs. 1.81 ± 0.34, p = 0.03; 0.80 ± 0.03 vs. 0.78 ± 0.02, p < 0.001, respectively). Both the mean PI and RI derived from the renal arteries, in contrast, were significantly higher in patients compared to that in controls (1.05 ± 0.13 vs. 1.11 ± 0.07, p = 0.03; 0.59 ± 0.03 vs. 0.63 ± 0.03, p < 0.001, respectively). The mean vascular impedance values obtained from the remaining arteries were comparable between the two groups. CONCLUSIONS: Blood flow increases in the common carotid and celiac arteries of Class-B cirrhotic patients with elevated renovascular impedance.

Correlation between Aortic Wall Thickness and Coronary Artery Disease by 64 Slice Multidetector Computed Tomography.

INTRODUCTION: Atherosclerotic cardiovascular disease is a dispersed pathology involving the coronary arteries, carotid arteries, aorta and peripheral arteries. It has been previously suggested that coronary and aortic atherosclerosis may be associated. Imaging of the aorta and the aortic wall can be performed by various imaging modalities including state-of-the-art multidetector computer tomography (MDCT). This study aimed to investigate a possible association between the MDCT-measured thickness of the thoracic aorta and the presence of coronary artery disease (CAD) as well as its severity. METHODS: Three hundred and fifty candidates of coronary computer tomography angiography (CTA) with signs and symptoms suggestive of CAD were recruited in Tabriz Parsian and Iran CTA Centers. Contrast-enhanced MDCT examinations were performed using a 64 detector scanner. Maximum aortic wall thickness in the mid-portion of descending thoracic aorta (region of pulmonary trunk to diaphragm) was measured perpendicular to the center of the vessel. RESULTS: CAD was confirmed in 189 cases (54%) and the remaining 161 cases served as controls. The mean age of the cases, as well as the percentage of male subjects was significantly higher in the CAD group. The mean aortic wall thickness was also significantly higher in the patient group (2.21±0.63 mm vs. 1.88±0.58 mm; P<0.001). In multivariate analysis, however, the two groups turned up comparable as to the aortic wall thickness (P=0.31). The optimal cut-off point of aortic wall thickness was ≥2 mm in discriminating between CAD+ and CAD- groups, with a corresponding sensitivity and specificity of 65% and 57%, respectively. There was no significant association between aortic wall thickness and the severity of CAD (the number of significantly occluded coronary arteries). CONCLUSION: Aortic wall thickness is apparently neither an independent predictor of CAD nor is it associated with the severity of CAD in candidates of CTA.

Anatomic variations of aortic arch branches and relationship with diameter of aortic arch by 64-row CT angiography.

There are different variations in the branching pattern of the Aortic Arch (AA). The aim of the present study was to study and evaluation of anatomic variations of aortic arch branches and relationship with diameter of aortic arch by 64-row computed tomography angiography (CT angiography). This descriptive analytical study was performed on 503 human by using of CT Angiography (CTA) to evaluation of anatomic variations of aortic arch. Patients underwent three dimensional restoration of aorta arch images and its branches using MIP and VRT software following intravascular injection of vein material (100 mL) and conducting CT. Then, kind of their divisions were registered. Additionally, diameter of aorta arch was measured at its cross section immediately before and after separation of its first and last branches, respectively. This study was performed on 503 specimen that 269 (53.5%) was male and 234 (46.5%) was female. The most common AA branching pattern was found in 346 (68.8%) of 503 specimens. There was no significant correlation between sex and type of variations (p = 0.073). There was no significant correlation between type of AA variations and AA diameter in the early branching area (p = 0.446) and there is no significant correlation between type ofAA variations and AA diameter in the last branching area (p = 0.887). The different branching patterns of the AA observed in this study and the morphometric measurements taken can assist doctors in performing safe and effective surgeries in the superior mediastinum and also a safe interventional procedures.

Common carotid artery intima-media thickness and atherosclerotic plaques in carotid bulb in patients with chronic kidney disease on hemodialysis: a case-control study.

The Common Carotid artery Intima-Media Thickness (CCIMT) can reflect systemic atherosclerosis in renal patients on hemodialysis. This study aimed to compare CCIMT measured by color Doppler ultrasonography between two groups including dialytic patients and normal subjects. In this case-control setting, 48 patients with Chronic Kidney Disease (CKD) on hemodialysis (case group) and 46 age and sex-matched healthy subjects (control group) were enrolled in this study. Color Doppler ultrasound was used to measure CCIMT and determine presence of atherosclerotic plaques in carotid bulb in both groups. Various laboratory parameters were also determined. Serum levels of triglyceride, total cholesterol, low-density lipoprotein, fasting sugar, ionized calcium, inorganic phosphorus and magnesium were comparable between the two groups. Hypertension and elevated levels of serum C-reactive protein, as well as the mean levels of serum non-fasting homocysteine and phosphate were significantly higher in the case group. Mean levels of serum high-density lipoprotein and albumin were significantly higher in the controls. Mean maximum CCIMT was significantly higher in the case group than in controls (0.73 +/- 0.15 vs. 0.68 +/- 0.08 mm, p = 0.01) even after adjusting for other confounding variables. Frequency of patients with atherosclerotic plaques in carotid bulbs was not significantly different between case and controls. In conclusion, this study showed that CCIMT is significantly higher in CKD patients on hemodialysis comparing with matched normal counterparts. Furthermore, this difference was independent of other conventional risk factors for atherosclerosis.

Common carotid intima-media thickness in patients with late rheumatoid arthritis; what is the role of gender?

This study aimed to evaluate color Doppler sonographic findings in carotid arteries in RA patients under pharmacological treatments and to compare them with normal population. Forty nine patients with late RA and 48 healthy age and sex-matched controls were recruited. The two groups were matched for other known risk factors of atherosclerosis including serum lipid abnormalities, smoking status, diabetes mellitus and hypertension. High resolution B-mode color Doppler ultrasound with a 7 MHZ transducer was used for measuring the Common Carotid Intima-Medial Thickness (CCIMT) in both sides in all subjects. Presence of atherosclerotic plaque was also investigated. The mean left and maximum CCIMT was significantly higher in the case group (0.72 vs. 0.62 mm for the left artery; p < 0.01; 0.72 vs. 0.64 mm for the maximum reading; p = 0.01). No atherosclerotic plaque was found in common carotid arteries. There were 3 (6.1), 7 (14.3) and 9 (18.4%) plaques in left internal carotid artery, right carotid bulb and left carotid bulb in the case group, respectively with no atherosclerotic plaques in the controls (p = 0.24, 0.01 and < 0.001, respectively). Comparing the findings by gender in the case group with the controls, the mentioned significant differences were only between the male patients and the controls. The process of atherosclerosis in RA patients is similar to that in normal population. However, it is apparently accelerated and more advanced in these patients.

Asymptomatic bilateral ureteropelvic junction obstruction due to supernumerary renal arteries.

A supernumerary renal artery is a common arterial variation, which warrants considerations in a variety of urologic and retroperitoneal operations. Supernumerary renal arteries can be associated with other uro-vascular variations and anomalies such as duplicated renal veins and ureters, aberrant origin of the gonadal arteries, persistence of fetal renal lobulation, and kidney malrotation. The role of crossing supernumerary renal arteries in ureteropelvic junction obstruction (UPJO) is controversial. We report a healthy potential renal transplant donor with bilateral UPJO, which appeared to be secondary to supernumerary renal (inferior polar) arteries. We believe that the bilateral occurrence of asymptomatic UPJO associated with supernumerary renal arteries has not been previously reported.

Peri-hilar branching patterns and morphologies of the renal artery: a review and anatomical study.

The peri-hilar (extra-parenchymal) branching pattern of the renal artery is important for surgeons to know prior to kidney transplantation. The aim of this study was to identify the variations in peri-hilar branching pattern and morphology of the main renal artery. Arteriograms of 81 kidneys were examined. After marking the renal shadow, the main renal artery was traced laterally from its origin. Morphologically, the arterial branching patterns were classified into ladder (with sequential branching points) and fork (with a common branching point) types. The latter was either duplicated or triplicated. The peri-hilar morphology of the main renal artery was then categorized according to its primary and secondary divisions and their patterns. If a single category encompassed at least 5% of the observed figures, it was recorded as a "cardinal" peri-hilar arterial morphology. Otherwise, it was counted within the category of "infrequent" morphologies. At the level of the main artery, a fork pattern was observed in 92.6% (n = 75) (80.2% duplicated (n = 65) and 12.4% triplicated (n = 10)) and a ladder pattern in 7.4% (n = 6) of kidneys. Of 160 primary branches off the fork-type main artery, a secondary division was found in 68.8%. Only one further division (4.4%) was noted from the ladder-type primary arteries. Eight "cardinal" peri-hilar renal arterial morphologies were identified and represented 82.7% of all cases. At least ten "infrequent" morphologies were also found. These patterns showed some alteration with the presence of a supernumerary renal artery. We concluded that the peri-hilar branching of main renal artery is highly variable, though this may follow certain patterns. We believe that the results may be useful to surgeons operating at the renal hilum especially during kidney transplantation.

Bipolar supernumerary renal artery.

The variations of renal arteries are considered critical issues that surgeons should have thorough envision and appreciation of the condition. Variations of these vessels may influences urological, renal transplantation and laparoscopic surgeries. We present a case of bilateral accessory renal artery with a striking pre-hilar branching pattern encountered upon digital subtraction angiography (DSA) for imaging of the renal arteries of a healthy 30-year-old man, renal transplant donor. The right kidney received two renal arteries from the aorta including a main hilar and one lower polar. However, the left accessory artery while originated from the aorta, simultaneously, supplied both upper and lower renal poles following its pre-hilar division that replaced upper/apical and lower segmental arteries of the single main renal artery, respectively. The left main renal artery divided into two anterior and posterior segmental arteries. Whether this should be categorized either as an accessory hilar artery or a unique variant of renal arterial supply, the so-called bipolar supernumerary renal artery, is a matter of debate. We discuss possible embryologic origin and clinical aspects of accessory renal artery.

Origins of the gonadal artery: embryologic implications.

The gonadal arteries are paired vessels that usually originate from the abdominal aorta at the level of second lumbar vertebra. In 5-20% of cases, the gonadal artery has a high origin (superior to L2) and in 5-6% of cases it originates from the main or accessory renal artery. The latter is referred to here as an aberrant gonadal artery. Ninety-eight kidneys of 50 healthy potential renal transplant donors were prospectively studied by conventional angiography. The renal artery, either main or accessory, was detected and individually injected to highlight their perihilar divisions and possible extrarenal branches. The gonadal arteries were recorded if they originated from the renal arteries. We found that 39% (n = 38) of kidneys had at least one accessory renal artery. In 14 sides (14% of kidneys), the gonadal artery (11 right and 3 left) originated from the renal artery, either main (n = 5) or accessory (n = 9). Ten out of 14 kidneys with an aberrant gonadal artery had an associated accessory renal artery. In nine cases, the gonadal artery originated from the accessory renal artery, and in one case, although it originated from the main renal artery, the same kidney had an accessory arterial supply. The results of this study demonstrate that aberrant gonadal arteries tend to originate from kidneys that possess an accessory arterial supply. We hypothesize that aberrancies of the gonadal artery are a part of a common embryologic error resulting in the persistence of the future accessory renal arteries. We believe that this study is the first to hypothesize and study such an association with these arterial anomalies of the renal pedicle.