Spontaneous rupture of a gastroduodenal artery side branch immediately following endovascular treatment of gastroepiploic artery aneurysm or pseudoaneurysm.

Key clinical massage: Pseudoaneurysms and aneurysms of the visceral arteries are rare entities. To the best of our knowledge, rupture of a proximal parental artery during endovascular treatment of a visceral aneurism/pseudoaneurysm has not been reported and should be kept in mind as a tragic possibility immediately following an apparently successful management of them. Abstract: A 55-year-old woman with a history of coronary artery disease was referred to our hospital with abdominal pain as her primary complaint. Early works revealed anemia, a small amount of free peritoneal fluid, and a possible large aneurysm or pseudoaneurysm by the greater curvature of the stomach. She underwent emergency angiography that showed a large aneurism/pseudoaneurysm of the gastroepiploic artery. Successful embolization of the lesion was performed using the isolation technique. Perforation of a side branch of the gastroduodenal artery was observed on the immediate postembolization control angiography. Therefore, parent artery coiling was done immediately with good results. She was symptom-free and stable hemodynamically after the procedure, during the hospital course, and in the follow-ups.

Comparison of renal function after Endovascular Aneurysm Repair and Open Aneurysm Repair in patients treated with abdominal aortic aneurysm below the renal artery.

INTRODUCTION: In addition to open endoaneurysmorrhaphy (EA) for treating the abdominal aortic aneurysm (AAA), other approaches such as endovascular aneurysm repair (EVAR) is gaining attention. Renal dysfunction could be a complication of these surgical techniques. We decided to compare renal function in EVAR vs. EA in patients operated for infrarenal AAAs. METHODS: Two groups of patients with AAA were included in this retrospective study. The first group (28 cases) consisted of patients who underwent AAA repair by EA technique and the second group included 12 patients who underwent EVAR for AAA repair. Serum creatinine levels measured one week, one month, three months, six months, and one year after the surgeries were documented. Through calculating the glomerular filtration rate (GFR) and scoring by the RIFLE criteria (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease), the patients' renal function was evaluated. RESULTS: Of 40 patients included, three cases had diabetes mellitus (7.5%), 16 cases had hypertension (40%), 16 were smokers (40%), and 12 cases had a ruptured AAA (30%). The mean time of onset or increase of renal dysfunction compared to baseline in both groups was 6.45 days. The lowest time for patients with renal dysfunction (GFR less than 60) was from the onset and the highest time was 90 days after surgery. GFR of patients before surgery (76.9 in the EVAR group, vs. 56.2 in the EA group; P = 0.015) and one year after the surgery (84.1 in the EVAR group, vs. 57.7 in the EA group; P = 0.027) was differed significantly. The RIFLE criterion also was significantly different at the end of the first year in the two groups (P = 0.042). CONCLUSION: Based on the results, we concluded that the changes in renal function in EA group were more than EVAR group during one year. It may be necessary to follow patients undergoing these surgeries for a longer period to understand the prognosis of these patients better.

Diagnostic value of doppler ultrasound indices of maternal renal interlobar vasculature in the prediction of preeclampsia.

We aimed to determine the diagnostic accuracy of maternal renal vasculature Doppler ultrasound indices in the prediction of preeclampsia. A total of 40 pregnant women with a gestational age of more than 20 weeks were included and followed. The pregnant women underwent a Doppler ultrasound examination to measure the resistance index (RI) of the interlobar arteries of right and left kidneys and the renal interlobar vein impedance index (RIVI). Of the included women, 15 patients developed preeclampsia based on clinical and laboratory criteria. The renal vascular Doppler ultrasound indices were compared between the two groups. Then, using the Receiver Operating Characteristic (ROC) analysis, the diagnostic accuracy of interlobar artery RI and RIVI were investigated in the prediction of preeclampsia occurrence. RIVI values of right and left kidneys were significantly higher in the preeclampsia group compared to the normal pregnancy group. The left kidney interlobar artery RI at a cut-point of 0.59 had a sensitivity of 100% and a specificity of 40% (area under curve=0.7, P-0.03) in the prediction of preeclampsia. The RIVI of the left kidney (adjusted odds ratio=17.14, 95% CI = 3.46 to 47.28) was statistically significant in predicting preeclampsia (P-0.006). We found that, besides other routine methods, using Doppler ultrasound and measuring RIVI can be reliable in the prediction of preeclampsia.