Stents in Renal Artery Bifurcation Stenosis: A Case Report

A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach

Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS). Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS), whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS). 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension

Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

Transplant renal artery stenosis (TRAS) is a well-known cause of posttransplant hypertension accompanied by possible graft dysfunction and is potentially curable when is diagnosed early. Colour Doppler Ultrasonography (CDU) is the screening procedure of choice in most studies whereas some centers employ Magnetic Resonance Angiography (MRA), if available. Although both CDU and MRA can arouse suspicion of disease in less symptomatic cases, angiographic techniques are essential for confirmation of TRAS. Percutaneous Transluminal Angioplasty (PTA) is a good and widespread therapeutic approach for the treatment of TRAS due to its acceptable complication rate and high technical success rate. The purpose of this paper is to assess the safety and efficacy of PTA in the treatment of TRAS, to compare the long-term outcomes between different reports, and to examine the role of PTA with stenting in inhibiting recurrence of the disease

Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature

<p>Abstract</p> <p>Introduction</p> <p>Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.</p> <p>Case presentations</p> <p>Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.</p> <p>Conclusions</p> <p>A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.</p

Contribution of virtual colonoscopy in the evaluation of tumorous masses of the colon: comparison with other techniques

Introduction. Virtual colonoscopy is a modern imaging technique which allows the 3D reconstruction and evaluation of the colon lumen. Numerous references suggest its value in several pathologies including polyps, colorectal cancer etc. Aim of the present study is to evaluate the efficacy of virtual colonography in the preoperative assessment as well as in the postoperative follow-up of patients with colorectal cancer. Material and Method. From 2001 to 2004 we performed virtual colonography in 129 patients with colorectal cancer. In 62/129 patients the exam performed preoperatively while in 67/129 postoperatively. The results of the method were compared with those from conventional colonoscopy, barium enema and the histological findings. Results. The efficacy of virtual colonography in the pre- and post- operative assessment of the patients with colorectal cancer is comparable concerning the diagnosis and the description of the lesions. Both these methods are safe and feasible. Virtual colonography presents the advantage of allowing the examination of the entire colon, even proximal from an occlusive lesion. Conventional colonoscopy has the advantage of taking biopsies, while virtual colonography combined with spiral CT presents better results concerning staging of the disease. Conclusions. Virtual colonography is safe, well tolerated method for examining the colon, and presents results comparable with those of the conventional colonoscopy. We believe that in the future it will be considered as a valuable tool in the preoperative and postoperative assessment of the patients with colorectal cancer or polyps.Η εικονική κολονοσκόπηση αποτελεί μία νεότερης γενιάς απεικονιστική τεχνική με την οποία γίνεται τρισδιάστατη αναπαράσταση του εσωτερικού του αυλού του παχέος εντέρου. Αρκετές αναφορές στη βιβλιογραφία υποδεικνύουν την αξία της μεθόδου στη διάγνωση διαφόρων παθολογιών του παχέος εντέρου όπως είναι ο καρκίνος, οι πολύποδες κοκ. Στόχος της παρούσας μελέτης είναι η διερεύνηση της αξίας της εικονικής κολονοσκόπησης στην προεγχειρητική διάγνωση και τη μετεγχειρητική παρακολούθηση ασθενών με ορθοκολικό καρκίνο. Υλικό και Μέθοδος: Στη διάρκεια της τριετίας 2001-2004 εξετάσθηκαν με εικονική κολονοσκόπηση 129 ασθενείς (79 άνδρες και 49 γυναίκες) μέσης ηλικίας 64,1 έτη (εύρος 28-92 έτη). 62 υποβλήθηκαν στα πλαίσια προεγχειρητικού ελέγχου και 67 για τη μετεγχειρητική παρακολούθηση μετά από επέμβαση για ορθοκολικό καρκίνο. Τα αποτελέσματα της εικονικής κολονοσκόπησης συγκρίθηκαν με εκείνα της συμβατικής κολονοσκόπησης, του βαριούχου υποκλυσμού και της ιστολογικής εξέτασης του χειρουργικού ή βιοπτικού υλικού. Αποτελέσματα: Η εικονική και η συμβατική κολονοσκόπηση είναι εξίσου αποτελεσματικές στη διάγνωση καρκίνων του παχέος εντέρου, και στην περιγραφή των χαρακτηριστικών του όγκου. Είναι και οι δύο ασφαλείς. Η εικονική κολονοσκόπηση φαίνεται ότι υπερτερεί στην ανεύρεση πολλαπλών αλλοιώσεων. Η εικονική κολονοσκόπηση πλεονεκτεί στο ότι επιτρέπει την εξέταση τμήματος που βρίσκεται κεντρικότερα από μία στενωτική αποφρακτική βλάβη, η οποία οδηγεί τη συμβατική κολονοσκόπηση σε αποτυχία. Η συμβατική κολονοσκόπηση προσφέρει το πλεονέκτημα της δυνατότητας λήψης βιοψίας, αλλά η εικονική κολονοσκόπηση συνδυαζόμενη με την ελικοειδή αξονική τομογραφία έχει καλύτερα αποτελέσματα στη σταδιοποίηση της νόσου. Συζήτηση. Γίνεται μία σύντομη ιστορική αναδρομή για να είναι κατανοητό πως αναπτύχθηκε αυτή η τεχνολογία. Περιγράφονται τα τεχνικά χαρακτηριστικά της μεθόδου, οι ενδείξεις, τα πλεονεκτήματα, τα μειονεκτήματα, οι περιορισμοί και τα απεικονιστικά χαρακτηριστικά σε κάθε παθολογία. Γίνεται μία αναφορά στις υπό μελέτη παθολογίες του παχέος εντέρου και ιδιαίτερα στον ορθοκολικό καρκίνο και τους πολύποδες του παχέος εντέρου, και τα ιδιαίτερα διαγνωστικά χαρακτηριστικά αυτών στην εικονική κολονοσκόπηση. Αναφέρονται οι εφαρμογές και ανασκοπείται λεπτομερώς η διεθνής βιβλιογραφία και πρακτική. Τέλος γίνεται μία σύντομη αναφορά στο θέμα του προσυμπτωματικού προληπτικού ελέγχου, στο κόστος και στις μελλοντικές προοπτικές της μεθόδου. Συμπεράσματα: Η εικονική κολονοσκόπηση είναι μία μέθοδος ασφαλής, καλά ανεκτή από τον ασθενή και με αποτελέσματα συγκρίσιμα με εκείνα της συμβατικής κολονοσκόπησης. Φαίνεται ότι η βελτίωση της μεθόδου και η εξέλιξη της τεχνολογίας θα συμβάλλει στην καθιέρωσή της ως αναπόσπαστου τμήματος στον προεγχειρητικό έλεγχο και στη μετεγχειρητική παρακολούθηση των ασθενών με ορθοκολικό καρκίνο ή πολύποδες του παχέος εντέρου

Case Report Stents in Renal Artery Bifurcation Stenosis: A Case Report

A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The &quot;kissing balloon&quot; technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a &quot;kissing&quot; way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach

Gastrointestinal and Extragastrointestinal Stromal Tumors: Report of Two Cases and Review of the Literature

We present two cases, one of a gastrointestinal stromal tumor (GIST) in the stomach and one of an extragastrointestinal stromal tumor (EGIST) in the hepatogastric ligament, which were discovered as incidental findings during computed tomography (CT) scans performed for other reasons. In both cases the diagnosis of the tumor was confirmed histologically and immunohistochemically. During the follow-up CT examinations these tumors proved to have a completely different natural course. The first case refers to an 82-year-old male patient with GIST of the stomach who refused to be operated and was followed by CT scans for a 4-year period. This patient did not show any significant changes in the morphology, size and density of the lesion. The second case refers to a 58-year-old female patient with EGIST of the hepatogastric ligament who presented with simultaneous liver metastases and remained healthy for 2 years after surgical resection, but developed local recurrence later. As a conclusion, both GISTs/EGISTs can be revealed as incidental findings in a CT scan performed for other purposes. Moreover, an untreated GIST located in the stomach can remain unchanged and without metastatic lesions for a long period of time, as in our case for a 4-year period. To our knowledge, this is the first report in the literature in whom a GIST was proved to remain almost unchanged for many years without any treatment, and we therefore attempt a further review of the current literature on stromal tumors

Autosomal dominant polycystic kidney disease: MR imaging evaluation using current techniques

To determine the MR imaging findings of autosomal dominant polycystic kidney disease using current imaging techniques. We reviewed our five-year experience with MR imaging of autosomal dominant polycystic kidney disease (ADPKD) to determine the spectrum of appearance of kidney disease, the occurrence of cysts in other abdominal organs, the size and number of cysts in the kidneys and other organs, and the association with other benign or malignant disease. Thirty patients (17 men and 13 women, age range 30 to 88 years old) with ADPKD were included in this study. All patients were examined by MR imaging including T2-weighted single-shot echo-train spin-echo and pre- and post-gadolinium chelate spoiled gradient-echo imaging. All kidneys were involved with multiple, varying sized cysts scattered throughout the parenchyma. Giant renal cysts (>8 cm) were associated with pain in the only two patients who possessed them. Hemorrhage in renal cysts was observed in all kidneys with a heterogeneous pattern of involvement on non-contrast T1- and T2-weighted images, reflecting hemorrhage of varying age. The mean kidney size for the right kidney was 17.4 cm in length, 10.3 cm in transverse, and 9.4 cm in antero-posterior diameter (AP); and for the left kidney, 15.9 cm in the length, 9.3 cm in the transverse, and 9.3 cm in AP diameter. Other organs involved included the liver (22 patients), the pancreas (three patients), with two of the above-mentioned patients having both liver and pancreas cysts, and the spleen (one patient) who had both liver and splenic cysts. Massive liver involvement with large cysts was associated with abdominal pain. Malignant disease was present in five patients, including two patients with renal cell carcinoma, one with bladder cancer, one with lung cancer, and one patient with anal adenocarcinoma. Comparison of pre- and post-contrast T1-weighted images was essential to detect renal cancer. All kidneys in patients with ADPKD had extensive, varying-sized cysts and in all cases some cysts showed evidence of hemorrhage. The liver was the second most common organ to be involved with cystic disease, in 73% of patients. Large cysts in the kidneys and liver were associated with abdominal pain