Linda M. Reilly, MD, Christopher G

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Presentation transcript:

The role of arterial reconstruction in spontaneous renal artery dissection Linda M. Reilly, MD, Christopher G. Cunningham, MD, Robert Maggisano, MD, William K. Ehrenfeld, MD, Ronald J. Stoney, MD Journal of Vascular Surgery Volume 14, Issue 4, Pages 468-479 (October 1991) DOI: 10.1016/0741-5214(91)90240-U Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Arteriogram shows normal right renal artery and two left renal arteries with the lower one being abnormal. B, Early phase of selective injection shows aneurysmally dilated false channel. C, Late phase of selective injection shows delayed perfusion of lower pole branches. Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Specimen of aneurysmal segment of resected artery from patient 3. A, The apparent lumen of the opened artery is actually the false channel of the dissection. B, This higher power view shows that the false lumen (a) occupies most of the vessel diameter. The original vessel wall (b) is collapsed such that the true lumen is a mere slit. Underneath the plane of dissection (c) organized hemorrhage separates the old wall from the false channel. (original magnification × 12.) Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Follow-up arteriogram shows the normal appearing hypogastric artery bypass graft. Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Midstream aortogram (A) and selective right renal artery injection (B) show long, tapering stenosis of most of the main renal artery produced by compression of the true lumen by the dissection. The dilated segment of the distal renal artery is the aneurysmal false channel, and it extends into the primary bifurcation. Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Cross-section of specimen from patient 7. A, The false lumen (a) compresses the smaller, but patent, true lumen (b). B, Higher power view shows that the outer elastic lamina (c) is separated from the adventitia (d) by a wedge of old organized hematoma (e) that has undergone fibroplasia. (original magnification × 120.) Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Late follow-up arteriogram (5 years after operation) shows the widely patent ex vivo repair, using a branched hypogastric artery interposition graft. Note stump of the left renal artery as a result of previous nephrectomy. Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Arteriogram shows diffuse involvement of the primary branches by dissection, with formation of multiple stenoses and aneurysms. Journal of Vascular Surgery 1991 14, 468-479DOI: (10.1016/0741-5214(91)90240-U) Copyright © 1991 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions