Introduction: We evaluated the feasibility of intraoperative transarterial balloon occlusion of renal artery as a novel technique to reduce blood loss in high-risk patients undergoing complex percutaneous renal surgery (PRS).
Methods: Four patients (staghorn calculi: n=2, renal pelvis TCC: n=1, ureteropelvic junction obstruction: n=1) underwent transfemoral arteriography prior to PRS. The renal artery was identified and an occluding balloon was inflated in the main renal artery. The kidney was intermittently allowed to perfuse with heparinized saline. Percutaneous renal access was obtained under fluoroscopic guidance by the urologist. Multiple tracts were established as needed to perform the procedure. The arterial occluding balloon was taken down at the completion of PRS and renal angiography repeated through the established angiographic catheter to identify any vascular injury.
Results: Subjective improved visualization was attributed to decreased bleeding. Blood loss was less than 500 cc. Post-PRS intraoperative angiography revealed no active bleeding vessels requiring embolization. Two of the four patients presented with delayed renal hemorrhage over 10 days later requiring angiography and selective embolization with cessation of bleeding. All vascular abnormalities identified on repeat angiogram were not present on immediate post-PRS angiography.
Conclusions: Intraoperative balloon occlusion of renal artery is feasible and safe in patients undergoing complex PRS. Vascular control improves intraoperative endoscopic visibility while reducing intraoperative blood loss in patients at high risk for bleeding. However, these patients can still be at risk for delayed hemorrhage as iatrogenic vascular abnormalities, which can cause bleeding, can take time to develop and not be evident immediately post PRS.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1089/end.2008.9701 | DOI Listing |
CEN Case Rep
January 2025
Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2, Toranomon, Minato, Tokyo, Japan.
A 54-year-old man who had been on the kidney donor register for 32 years received a kidney from a 9-year-old boy who had died of fulminant myocarditis. The post-operative course was poor, and hemodialysis was still needed after surgery. A kidney biopsy one hour after surgery showed a neutrophil-predominant inflammatory cell infiltrate localized to the peritubular capillaries (PTC) and acute tubular necrosis of the proximal tubule.
View Article and Find Full Text PDFBr J Hosp Med (Lond)
December 2024
Department of Interventional Diagnosis and Treatment, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China.
This study aims to evaluate the safety and efficacy of α-n-butyl-2-cyanoacrylate (NBCA) glue in comparison with traditional embolization materials for the treatment of acute renal hemorrhage. A total of 105 patients with the acute renal hemorrhage who underwent superselective renal artery embolization were enrolled. The patients were divided into two groups based on the embolization materials used: the traditional group (43 cases, control group) and the medical glue group (62 cases, observation group).
View Article and Find Full Text PDFJ Thorac Dis
December 2024
Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a prevalent complication with poor outcomes, and its early prediction remains a challenging task. Currently available biomarkers for acute kidney injury (AKI) include serum cystatin C (sCysC) and urinary N-acetyl-β-D-glucosaminidase (uNAG). Widely used biomarkers for assessing cardiac function and injury are N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI).
View Article and Find Full Text PDFBackground: When inserting central venous catheters, inadvertent injury of major vessels is a rare yet critical complication. Direct surgery is sometimes overly invasive. This report describes a subclavian artery injury caused by inadvertent cannulation of a dialysis catheter, successfully treated with a covered stent.
View Article and Find Full Text PDFESC Heart Fail
January 2025
Department of Cardiology, Pulmonology, and Intensive Care Medicine, Center for Molecular Medicine Cologne (CMMC), Cologne Cardiovascular Research Center (CCRC), Medical Faculty, University of Cologne, Cologne, Germany.
Aims: Despite receiving guideline-directed medical heart failure (HF) therapy, patients with pulmonary hypertension associated with left heart disease (PH-LHD) experience higher mortality and hospitalization rates than the general HF population. AZD3427 is a functionally selective, long-acting mimetic of relaxin, a hormone that has the potential to induce vasodilation and prevent fibrosis. In a phase 1b study conducted in patients with HF, AZD3427 demonstrated a favourable safety and pharmacokinetic profile.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!