Preoperative renal arterial embolization in high-risk nephrectomy: A case report of a 48-year-old patient with severe emphysematous pyelonephritis.

A 48-year-old female with a background history of alcoholic liver cirrhosis and noninsulin-dependent diabetes presented to our institution with emphysematous pyelonephritis of the right kidney diagnosed on CT. Both urine and blood culture grew multidrug-resistant Escherichia coli. The patient developed severe thrombocytopenia, hyponatremia, confusion as well as septic shock. Preoperative right renal arterial embolization was performed, followed by immediate primary nephrectomy. This article reports the first documented case of preoperative angioembolization to prevent severe intraoperative hemorrhage and vascular complications in severe emphysematous pyelonephritis.

Replacement of the aortic root with a composite valve-graft conduit: risk factor analysis in 246 consecutive patients.

BACKGROUND: Composite valve-graft (CVG) replacement of the aortic root is a well-studied and recognised treatment for various aortic root conditions, including valvular disease with associated aortopathy. There have been few previous studies of the procedure in large numbers in an Australian setting. METHOD: From January 2006 to June 2013, 246 successive patients underwent CVG root replacements at our institution. Mean age was 56.8 years, 85.4% were male, and 87 had evidence of bicuspid aortic valve. Indications for operation included ascending aortic aneurysm in 222 patients, annuloaortic ectasia in 67 patients, and aortic dissection in 38 patients. RESULTS: The overall unit 30-day mortality was 5.7%, including: elective 30-day mortality of 2.2%, and emergent 30-day mortality of 17.2%. Statistically significant multivariate predictors of 30-day mortality were: acute aortic dissection (OR=20.07), peripheral vascular disease (OR=11.17), new ventricular tachycardia (OR=30.17), re-operation for bleeding (OR=14.42), concomitant mitral stenosis (OR=68.30), and cerebrovascular accident (OR=144.85). CONCLUSIONS: Low postoperative mortality in our series matches closely with results from similar sized international studies, demonstrating that this procedure can be performed with low risk in centres with sufficient experience in the operative procedure.