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Title: Delayed rupture of renal artery after renal percutaneous transluminal angioplasty

Abstract

Two cases are reported in which rupture of the renal artery occurred many hours after renal percutaneous transluminal angioplasty. Delayed rupture can be recognized by the angiographic appearance and by the presence of persistent flank pain. The typical angiographic finding is a poorly defined zone of contrast medium at the site of perforation.

Authors:
; ; ; ; ;
Publication Date:
Research Org.:
Departments of Radiodiagnosis, Univ. Hospital, Catharijnesingel 101, 3511 GV Utrecht
OSTI Identifier:
7063959
Report Number(s):
CONF-861136-
Journal ID: CODEN: RADLA; TRN: 87-013289
Resource Type:
Conference
Resource Relation:
Journal Name: Radiology; (United States); Journal Volume: 159:3; Conference: 72. scientific assembly and annual meeting of RSNA, Chicago, IL, USA, 30 Nov 1986
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; BIOLOGICAL REPAIR; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; KIDNEYS; BIOLOGICAL RADIATION EFFECTS; BIOLOGICAL RECOVERY; PATIENTS; SIDE EFFECTS; BIOLOGICAL EFFECTS; BODY; CARDIOVASCULAR SYSTEM; DIAGNOSTIC TECHNIQUES; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIATION EFFECTS; RADIOLOGY; RECOVERY; REPAIR; 550603* - Medicine- External Radiation in Therapy- (1980-)

Citation Formats

Puijlaert, C.B.A.J., Mali, W.P., Rosenbusch, G., van Straalen, A.M., Klinge, J., and Feldberg, M.A.M. Delayed rupture of renal artery after renal percutaneous transluminal angioplasty. United States: N. p., 1986. Web.
Puijlaert, C.B.A.J., Mali, W.P., Rosenbusch, G., van Straalen, A.M., Klinge, J., & Feldberg, M.A.M. Delayed rupture of renal artery after renal percutaneous transluminal angioplasty. United States.
Puijlaert, C.B.A.J., Mali, W.P., Rosenbusch, G., van Straalen, A.M., Klinge, J., and Feldberg, M.A.M. 1986. "Delayed rupture of renal artery after renal percutaneous transluminal angioplasty". United States. doi:.
@article{osti_7063959,
title = {Delayed rupture of renal artery after renal percutaneous transluminal angioplasty},
author = {Puijlaert, C.B.A.J. and Mali, W.P. and Rosenbusch, G. and van Straalen, A.M. and Klinge, J. and Feldberg, M.A.M.},
abstractNote = {Two cases are reported in which rupture of the renal artery occurred many hours after renal percutaneous transluminal angioplasty. Delayed rupture can be recognized by the angiographic appearance and by the presence of persistent flank pain. The typical angiographic finding is a poorly defined zone of contrast medium at the site of perforation.},
doi = {},
journal = {Radiology; (United States)},
number = ,
volume = 159:3,
place = {United States},
year = 1986,
month = 6
}

Conference:
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  • To characterize the sequential changes of myocardial perfusion scintigraphy in patients with coronary artery disease (CAD) after complete revascularization, 43 patients underwent exercise thallium-201 (/sup 201/Tl) myocardial perfusion scintigraphy before and at 9 +/- 5 days, 3.3 +/- 0.6, and 6.8 +/- 1.2 months after percutaneous transluminal coronary angioplasty (PTCA). Only patients with single-vessel CAD, without previous myocardial infarction, and without evidence of restenosis at 6 to 9 months after PTCA were included. Perfusion scans were analyzed blindly with the use of a new quantitative method to define regional myocardial perfusion in the topographic distribution of each coronary artery, whichmore » was shown to be reproducible (r = .94 or higher and SEE of 7% or less, between repeated measures by one and two operators). At 4 to 18 days after PTCA, the mean treadmill walking time increased by 123 +/- 42 sec, mean exercise-induced ST segment depression decreased by 0.6 +/- 0.3 mm, group maximal heart rate increased by 20 +/- 9 beats/min, and group systolic blood pressure at peak exercise increased by 24 +/- 10 mm Hg, compared with pre-PTCA values (p less than .001). However, no group differences were noted in these variables between the three post-PTCA stages. Myocardial perfusion in the distribution of the affected (dilated) coronary artery, on the other hand, improved progressively. In the 45 degree left anterior oblique view for instance, myocardial perfusion increased at 9 days after PTCA (from 68 +/- 24% before PTCA to 91 +/- 9%, p less than .001) and at 3.3 months after PTCA (101 +/- 8%, p less than .05 vs 9 days after PTCA), but no further significant changes were seen at 6.8 months after PTCA (102 +/- 8%). Similar changes were noted in the other two views. No relationship between minor complications during PTCA and delayed improvement on the /sup 201/Tl was observed.« less
  • Purpose: Predicting therapeutic benefit from percutaneous transluminal renal angioplasty (PTRA) in patients with renal artery stenosis (RAS) remains difficult. This study investigates whether magnetic resonance (MR)-based renal artery flow measurements relative to renal parenchymal volume can predict clinical outcome following PTRA.Methods: The data on 23 patients (13 men, 10 women; age range 47-82 years, mean age 64 years) were analyzed. The indication for treatment was hypertension (n = 18) or renal insufficiency (n = 5). Thirty-four cases of RAS were identified: bilateral disease was manifest in 11 and unilateral disease in 12 patients. The MR imaging protocol included a breath-hold,more » cardiac-gated cine phase-contrast sequence for renal flow measurement and a fast multiplanar spoiled gradient-echo sequence for renal volume measurement. MR measurements were performed on the day prior to and the day following PTRA. Clinical success was defined as (a) a reduction in diastolic blood pressure > 15% or (b) a reduction in serum creatinine > 20%. Kidneys were categorized as normal volume or low volume. A renal flow index (RFI) was calculated by dividing the renal flow (ml/min) by the renal volume (cm{sup 3}).Results: Clinical success was observed in 11 patients. Twelve patients did not benefit from angioplasty. Normal kidney volume was seen in 10 of 11 responders and in 8 of 12 nonresponders, resulting in a sensitivity of 91%, specificity of 33%, a positive predictive value (PPV) of 56% and a negative predictive value (NPV) of 80%. A RFI below a threshold of 1.5 ml/min/cm{sup 3} predicted successful outcome with 100% sensitivity, 33% specificity, 58% PPV, and 100% NPV. The combination of normal renal volume and a RFI below 1.5 ml/min/cm{sup 3} identified PTRA responders with a sensitivity of 91%, a specificity of 67%, a PPV of 71%, and a NPV of 89%. PTRA resulted in a greater increase in renal flow in responders compared with nonresponders (p < 0.001).Conclusion: A combination of cine phase-contrast MR renal flow and parenchymal volume measurements enables identification of patients benefiting from PTRA with a high sensitivity and NPV, but only moderate specificity and PPV.« less
  • Twenty-eight patients with a total of 32 stenoses of the renal artery were examined by angiography 6 months following percutaneous transluminal angioplasty (PTA). The angiograms were obtained: 1) prior to PTA; 2) immediately following PTA; and 3) 6 months later. These angiograms were compared and the relationship of diameter of the stenosis (A) of the poststenotic region (B) was evaluated. In 22 cases (78.5%), 6 months post-PTA, the stenoses were no longer demonstrated; stenosis diameter (A) showed an average increase from 2.1 to 5.1 mm, while the poststenotic region (B) decreased from 7.7 to 5.6 mm on average. Five casesmore » of partial stenoses (17.8%) seen on angiograms 6 months after PTA still showed a marked difference between A and B, with only a minimal reduction in area of B. In five patients with restenosis (17.8%), nearly the same results were obtained as in the pre-PTA state. Neither aneurysms nor renal arterial obstruction was found in our patient group. Rather, in most of our patients normalization of the renal vessels could be demonstrated on angiograms, supporting the choice of PTA as the preferred method of treatment of renal artery stenosis.« less
  • Purpose: To examine the extent of the changes in the intrarenal spectral waveform patterns after percutaneous transluminal angioplasty (PTA) and whether there is a correlation with the angiographic and clinical results. Methods: In 44 patients with 68 PTAs we analyzed the intrarenal spectral waveform regarding the existence of a tardus-parvus pattern before and after PTA. Results: In 51 of the 60 cases with a tardus-parvus pattern prior to PTA, a complete normalization of the spectral waveform was noted. There was no correlation between the Doppler result after PTA and the angiographic and clinical result. In contrast there was a significantmore » correlation between the Doppler result before PTA and the clinical outcome: patients with a normal intrarenal spectral waveform before PTA showed no improvement in their arterial hypertension. Conclusion: Our results indicate that a patient with a normal spectral waveform analysis does not response to PTA. However, there is still an unpredictable clinical response even if a patient has an abnormal intrarenal spectral waveform prior to PTA and a complete normalization after PTA.« less
  • Purpose: Retrospective analysis of the dilatation (PTRA) of renal arterial dysplastic stenosis (RADS). Methods: Seventy patients suffering from hypertension (87RADS) were treated at our institution for medial (83%) or non-classified fibrodysplasias (17%). Four patients suffered from renal insufficiency. Two endoprostheses were implanted. We evaluated blood pressure with the USCSRH criteria and renal insufficiency with the Martin criteria. Results: Ninety-five percent technical success and 87.9% clinical success for blood pressure were obtained, with worse results for patients older than 57 years or with a history of hypertension greater than 9 years. Results were better when the RADS was responsible for anmore » ipsilateral renal atrophy or for poorly controlled hypertension. No renal insufficiency worsened during the follow-up. Conclusion: PTRA is a first-line treatment for renovascular hypertension caused by RADS. The results were encouraging despite a high average age of the subjects and frequent associated extrarenal vascular lesions.« less