Renal Artery Intervention

Renal artery stenosis (RAS), hypertension and renal insufficiency (RI) are each frequently present especially in the elderly population. RAS is often present without any clinical signs or symptoms and even when hypertension or renal insufficiency are also present, they may be coincidentally rather than causally related. However, when RAS is hemodynamically or physiologically significant, it is one of the few potentially reversible causes of RI and hypertension.The challenge for physicians is to identify patients with RAS who would benefit from renal revascularization, whether by interventional techniques or open surgery. RAS is often clinically silent, at least until it becomes hemodynamically significant when it can produce renal vascular hypertension (RVH) or RI

Correlation between mesenteric fat thickness and serum apolipoproteins in patients with peripheral arterial occlusive disease

BACKGROUND: Visceral fat possesses the most detrimental potential for cardiovascular morbidity through the release of adipokines, as well as metabolic and proinflammatory mediators, which adversely affect metabolic and vascular homeostasis. Among the different types of visceral adipose tissue, mesenteric fat is considered particularly detrimental, due to its close proximity to the portal circulation, affecting directly the liver, which is the main regulator of body metabolic homeostasis. Mesenteric fat can be reliably estimated using abdominal ultrasonography, the only available imaging method able to depict individual mesenteric leaves. Aim of the present study was to investigate the correlation of mesenteric fat thickness (MFT) with serum apolipoprotein levels in patients undergoing digital subtraction angiography in a single center. METHODS: 35 male patients with peripheral arterial disease were examined. After careful examination of the periumbilical area, the mesenteric leaves were identified. The maximal distance between each pair of sequential leaves was measured, and the mean value of the three thickest leaves was determined as the mesenteric fat thickness. Six apolipoprotein fasting serum concentrations were measured using a Luminex proteomics platform (xMAP Multiplex immunoassay): apolipoprotein A-I (apoAI), apolipoprotein A-II (apoAII), apolipoprotein B (apoB), apolipoprotein C-II (apoCII), apolipoprotein C-III (apoCIII) and apolipoprotein E (apoE). RESULTS: MFT correlated with apoAII and apoB serum concentrations. The correlations with apoAII and apoB remained significant following correction for BMI. No correlations were noted between MFT and serum apoAI, apoCII, apoCIII or apoE levels before or after adjustment for BMI. CONCLUSIONS: Our study indicates that MFT is significantly correlated with the concentration of atherogenic low density lipoproteins particles, as well as with apoAII, a determinant of free fatty acids levels. No correlation was observed between mesenteric fat thickness and very low density lipoprotein or chylomicron particles concentration

Late renal artery occlusion following endovascular repair of abdominal aortic aneurysm: a possible complication of mural thrombus formation within aortic endografts

Mural thrombus formation within aortic endoprostheses has been described to occur in up to one-third of aortic endografts depending on the device type. Data regarding the clinical significance of such a phenomenon are scarce, but in most cases it is considered to be clinically innocent. The authors describe a rare case of late renal artery occlusion due to intraprosthetic thrombus formation and extension into the right renal orifice 30 months after endovascular abdominal aortic aneurysm repair. Additionally, a brief literature review regarding the incidence and natural history of mural thrombotic deposits within aortic endografts is also conducted

Unilateral Iliac Artery Stenting Improves Perfusion and Symptoms in Both Limbs in Patients With Bilateral Iliac Lesions

Purpose: To test the hypothesis that unilateral dilation of a common (CIA) or internal iliac artery (IIA) stenosis in selected patients with contralateral chronic iliac artery occlusion is adequate to offer clinical benefit to the untreated chronically occluded limb. Methods: Sixteen patients (11 men; mean age 66.7 +/- 4.9 years) with chronic occlusion of one CIA [with or without extension to the external iliac artery (EA)] and CIA stenosis (n=11), IIA stenosis (n=3), CIA and IIA stenoses (n=1), or IIA and EIA stenoses (n=1) on the contralateral side were treated with unilateral angioplasty/stenting of the iliac artery stenosis as sole treatment for both limbs. Clinical and hemodynamic success of this approach was assessed for both limbs. Results: Eleven patients were treated with stenting of the stenosed CIA, 2 with IIA dilation, one with IIA stenting, one with stenting of both the CIA and IIA, and the last with IIA and EIA stenting. Technical success was obtained in all. Immediate hemodynamic success was also 100% for both limbs: the mean resting ankle-brachial index increased from 0.67 +/- 0.06 to 0.88 +/- 0.04 on the stenosis side and from to 0.53 +/- 0.06 to 0.69 +/- 0.07 in the contralateral occluded limb (p<0.001). Clinical success was 100% for the treated limb immediately after the procedure and 93.8% for the contralateral limb. One patient with ischemic rest pain in the occluded limb continued to experience severe symptoms after contralateral CIA stenting despite hemodynamic improvement; he had a femorofemoral graft implanted 2 months after the initial intervention and was considered the only clinical failure. During a mean 24-month follow-up (range 12-54), all stented arteries remained patent. Conclusion: In selected patients with CIA or IIA stenosis and long chronic occlusion of the contralateral iliac axis, unilateral dilation/stenting of the stenosis alone increases blood flow and improves clinical symptoms to both limbs. J Endovasc Ther. 2013;20:106-11

Multiple Aneurysms of the Inferior Pancreaticoduodenal Artery: A Rare Complication of Acute Pancreatitis

Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed

Endovascular treatment of a vertebral artery pseudoaneurysm in a drug user

A 26-year-old drug abuser who presented with sepsis was found to have a pseudoaneurysm in the left vertebral artery. This aneurysm was presumed to be post-traumatic, since the patient reported multiple attempts to inject drugs in the left jugular vein 15 days prior to admission. The pseudoaneurysm was treated effectively with stent-graft placement

Moyamoya Disease May Mimic Multiple Sclerosis?

Introduction. A wide range of medical conditions may mimic multiple sclerosis. Among them, cerebrovascular diseases, including moyamoya disease, need to be excluded since they share common clinical features and radiographic findings with multiple sclerosis. Case Report. A 44-year-old woman experienced transient numbness of her right sided face and arm and was referred to our unit due to small brain lesions in magnetic resonance imaging, with a possible diagnosis of multiple sclerosis. Neurological examination was unremarkable except for plantar reflexes and jerky deep tendon reflexes. Brain magnetic resonance angiography revealed findings typically seen in moyamoya disease, confirmed with digital subtraction angiography. Antiplatelet therapy started, but few days later, she developed suddenly global aphasia and right hemiparesis (National Institutes of Health Stroke Scale/NIHSS 6). Brain magnetic resonance imaging revealed acute infarct in the distribution of the left middle cerebral artery. At her discharge, she was significantly improved (NIHSS 3). Conclusion. Diagnosis of multiple sclerosis is often challenging. In particular, in young patients with transient neurological symptoms and atypical white matter lesions in magnetic resonance imaging, cerebrovascular disorders such as moyamoya disease should be considered in the differential diagnosis. Detailed clinical and neuroimaging evaluation are mandatory for the correct diagnosis