Jeffrey L. Kaufman, MD, Charles R. Dinerstein, MD, Dhiraj M

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Presentation transcript:

Renal artery intimal flaps after blunt trauma: Indications for nonoperative therapy  Jeffrey L. Kaufman, MD, Charles R. Dinerstein, MD, Dhiraj M. Shah, MD, Robert P. Leather, MD  Journal of Vascular Surgery  Volume 8, Issue 1, Pages 33-37 (July 1988) DOI: 10.1016/0741-5214(88)90240-6 Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Intraarterial digital subtraction angiogram (case 1). There is intimal flap in midportion of the extrahilar left renal artery (arrow), without distal branch occlusion. Journal of Vascular Surgery 1988 8, 33-37DOI: (10.1016/0741-5214(88)90240-6) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Renal scan performed at the time of discharge (case 1). Upper set of curves is derived from rapid-sequence scanning and shows renal accumulation of radiolabeled material. Slope of the initial uptake correlates with early renal perfusion. Data for the kidneys (marked Rt and Lt) are accumulated over the regions outlined in scans depicted at the bottom of the figure and are compared with a separate aortic flow region (not shown). Rate of initial uptake for both kidneys is normal in comparison to the aorta (Aor). Middle curves compare radiolabel excretion from the two kidneys, with demonstrable reduction on the left. These studies remained unchanged 4 months after injury and indicated continued patency of the left renal artery. Journal of Vascular Surgery 1988 8, 33-37DOI: (10.1016/0741-5214(88)90240-6) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Arteriogram (case 2) and (B) schematic diagram of the right renal artery. There is an intimal flap in midportion of the right renal artery (arrow), occlusion of an upper pole branch, and an upper pole hematoma. Journal of Vascular Surgery 1988 8, 33-37DOI: (10.1016/0741-5214(88)90240-6) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Renal scan (case 2), processed in an identical manner to those presented in Fig. 2. Upper curves, derived from rapid sequence scanning, demonstrate nearly identical early radiolabel uptake. Middle curves, demonstrating renal excretion, show global reduction in right renal function. A series of such scans was identical up to 2 months after injury, indicating right renal artery patency. Journal of Vascular Surgery 1988 8, 33-37DOI: (10.1016/0741-5214(88)90240-6) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Follow-up selective right renal arteriogram, case 2. Intimal flap is no longer present, the right upper pole branch has become patent but is still abnormal in contour, and the right upper pole hematoma has partially resolved. Journal of Vascular Surgery 1988 8, 33-37DOI: (10.1016/0741-5214(88)90240-6) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions