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Renal Artery Dissections

Renal Artery Dissections Abstract • Renal artery dissections encountered in 15 patients, aged 3 to 75 years, were categorized as to pathogenesis (blunt abdominal trauma, catheter injury, and spontaneous). Blunt traumatic dissections (seven patients) were characterized by hypertension, gross hematuria, and pain. Catheter-induced dissections (four patients) were asymptomatic, although two exhibited accelerated hypertension. Spontaneous dissections (four patients) were all associated with preexistent arterial disease. Symptoms in these patients were uncommon, despite accelerated hypertension in three cases. Intravenous pyelography lacked specific diagnostic value for renal artery dissections. Early arteriographic examination proved essential in diagnosis and surgical treatment. Criteria for operative intervention included existence of technically correctable dissections causing (1) hemodynamically significant occlusions of the main or major segmental renal arteries, (2) documented renovascular hypertension, or (3) significant deterioration of renal function. (Arch Surg 112:409-414, 1977) References 1. Boyd JF, Watson AF: Dissecting aneurysms due to trauma . Scott Med J 1:326-329, 1956. 2. Englund GW: Primary dissecting aneurysm of the renal artery: Report of a case and review of the literature . Am J Clin Pathol 45:472-479, 1966. 3. Foord AG, Lewis RD: Primary dissecting aneurysms of peripheral and pulmonary arteries: Dissecting hemorrhage of media . Arch Pathol 68:553-577, 1959. 4. Gilfillan RS, Smart WR, Bostwick WL: Dissecting aneurysm of the renal artery . Arch Surg 73:737-740, 1956.Crossref 5. Grablowsky OM, Weichert RF III, Goff JB, et al: Renal artery thrombosis following blunt trauma: Report of four cases . Surgery 67:895-900, 1970. 6. Guthrie W, Maclean H: Dissecting aneurysms of arteries other than the aorta . J Pathol 108:219-235, 1972.Crossref 7. Hare WSC, Kincaid-Smith P: Dissecting aneurysm of the renal artery . Radiology 97:255-263, 1970.Crossref 8. Harrison EG Jr, Hunt JC, Bernatz PE: Morphology of fibromuscular dysplasis of the renal artery in renovascular hypertension . Am J Med 43:97-117, 1967.Crossref 9. Henry L, Burke WD: Isolated dissecting aneurysms of the renal artery . Angiology 14:269-276, 1963.Crossref 10. Kauffman JJ, Coulson WF, Lecky JW, et al: Primary dissecting aneurysm of renal artery: Report of a case causing reversible renal hypertension . Ann Surg 177:259-263, 1973.Crossref 11. Khanna OP, Nedwick A, Gonick A: Accelerated hypertension due to intramural dissection of accessory renal artery . Urology 1:130-133, 1973.Crossref 12. Liebow IM, Cline T, Post RS, et al: Isolated bilateral simultaneous dissection of the renal arteries . Am J Med 21:151-156, 1956.Crossref 13. Meyers DS, Grim CE, Keitzer WF: Fibromuscular dysplasia of the renal artery with medial dissection: A case simulating polyarteritis nodosa . Am J Med 56:412-416, 1974.Crossref 14. Neuman HW, Sakin AF: Unilateral dissecting aneurysm of the renal artery . Can J Surg 8:291-295, 1965. 15. Perry MO: Hypertension and dissecting aneurysms of the renal artery . Arch Surg 102:216-217, 1971.Crossref 16. Rosenblum WI: Isolated dissecting aneurysm of the renal artery . J Urol 95:135-138, 1966. 17. Skinner DG: Traumatic renal artery thrombosis: A successful thrombectomy and revascularization . Ann Surg 177:264-267, 1973.Crossref 18. Stables DP, Fouche RF, DeVilliers Van Neiker JP, et al: Traumatic renal artery occlusion: Twenty-one cases . J Urol 115:229-233, 1976. 19. Tuqan NA: Primary dissecting aneurysm of the renal artery . J Pathol Bacteriol 89:369-370, 1965.Crossref 20. Wadhwani IB, Johenning PW, Jawa PS: Unusual sequelae following blunt trauma to renal pedicle . Urology 3:79-81, 1974.Crossref 21. Watson AJ: Dissecting aneurysms of arteries other than the aorta . J Pathol Bacteriol 72:439-449, 1956.Crossref 22. Wheat MW Jr, Palmer RF: Dissecting aneurysms of the aorta . Curr Probl Surg , (July) , 1971. 23. Prokop EK, Wheat MW Jr, Palmer RF: Hydrodynamic forces in dissecting aneurysms . Circ Res 27:121-127, 1970.Crossref 24. Spencer MP, Dennison AB: Pulsatile blood flow in the vascular system , in Hamilton WR (ed): Handbook of Physiology . Washington, DC, American Physiological Society, 1963, vol 2, pp 839-864. 25. Lim RC Jr, Eastman AB, Blaisdell FW: Renal autotransplantation: Adjunct to repair of renal vascular lesions . Arch Surg 105:847-852, 1972.Crossref 26. Collins HA, Jacobs JK: Acute arterial injuries due to blunt trauma . J Bone Joint Surg 43A:193-196, 1961. 27. Ross R, Ackerman E, Pierce JM: Traumatic subintimal hemorrhage of the renal artery . J Urol 104:11-13, 1970. 28. Caponegro PJ, Leadbetter GW: Traumatic renal artery thrombosis . J Urol 109:769-771, 1973. 29. Evans A, Mogg RA: Renal artery thrombosis due to closed trauma . J Urol 105:330-334, 1971. 30. Sturm JT, Perry JF, Cass AS: Renal artery and vein injury following blunt trauma . Ann Surg 182:696-698, 1975.Crossref 31. Itzchak Y, Adar R, Moses M, et al: Occlusion of renal and visceral arteries following blunt abdominal trauma: Angiographic observations . J Cardiovasc Surg 15:383-388, 1974. 32. Morse TS, Harris BH: Nonpenetrating renal vascular injuries . J Trauma 13:497-501, 1973.Crossref 33. Marks LS, Brosman SA, Lindstrom RR, et al: Arteriography in penetrating renal trauma . Urology 3:18-22, 1974.Crossref 34. Flaster SL, Bush IM: The use of intraoperative renal arteriography in evaluating renal injuries . J Urol 109:763-765, 1973. 35. Guerrier K, Albert DJ, Mahoney SA, et al: Delayed nephrectomy after trauma . J Trauma 9:465-469, 1969.Crossref 36. Jacdo ET, Reisin E, Golan M, et al: Ex situ renal artery angioplasty followed by heterotropic autotransplantation of kidney in renal arterial thrombosis . Vase Surg 7:238-246, 1973.Crossref 37. Fay R, Brosman S, Lindstrom R, et al: Renal artery thrombosis: A successful revascularization by autotransplantation . J Urol 111:572-576, 1974. 38. Bergentz SE, Faarup P, Hegedus V, et al: Diagnosis of hypertension due to occlusion of a supplemental renal artery; its localization, treatment by removal from the body, microsurgical repair and reimplantation: A case report . Ann Surg 178:643-647, 1973.Crossref 39. Stanley JC, Gewertz BL, Bove EL, et al: Arterial fibrodysplasia: Histopathologic character and current etiologic concepts . Arch Surg 110:561-566, 1975.Crossref 40. McCormack LJ, Poutasse EF, Meaney TF, et al: A pathologic-arteriographic correlation of renal arterial disease . Am Heart J 72:188, 1966.Crossref 41. Reich SB, Riley JC III, Christopher RA, et al: Changes in pulse wave form with flow through vessels with repetitive saccular dilatations and stenosis . Invest Radiol 10:622-626, 1975.Crossref 42. Flanigan DP, Tullis JP, Streeter VL, et al: Multiple subcritical arterial stenoses: Effect on poststenotic pressure and flow. Ann Surg. to be published. 43. Nalbandian RM, Chason JL: Intramural (intramedial) dissecting hematomas in normal and otherwise unremarkable coronary arteries . Am J Clin Pathol 43:348-356, 1965. 44. Stanley JC, Rhodes EL, Gewertz BL, et al: Renal artery aneurysms: Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilatations . Arch Surg 110:1327-1333, 1975.Crossref 45. Ehrenfeld WK, Wylie EJ: Spontaneous dissection of the internal carotid artery . Arch Surg 111:1294-1301, 1976.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1977.01370040061009
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Abstract

Abstract • Renal artery dissections encountered in 15 patients, aged 3 to 75 years, were categorized as to pathogenesis (blunt abdominal trauma, catheter injury, and spontaneous). Blunt traumatic dissections (seven patients) were characterized by hypertension, gross hematuria, and pain. Catheter-induced dissections (four patients) were asymptomatic, although two exhibited accelerated hypertension. Spontaneous dissections (four patients) were all associated with preexistent arterial disease. Symptoms in these patients were uncommon, despite accelerated hypertension in three cases. Intravenous pyelography lacked specific diagnostic value for renal artery dissections. Early arteriographic examination proved essential in diagnosis and surgical treatment. Criteria for operative intervention included existence of technically correctable dissections causing (1) hemodynamically significant occlusions of the main or major segmental renal arteries, (2) documented renovascular hypertension, or (3) significant deterioration of renal function. (Arch Surg 112:409-414, 1977) References 1. Boyd JF, Watson AF: Dissecting aneurysms due to trauma . Scott Med J 1:326-329, 1956. 2. Englund GW: Primary dissecting aneurysm of the renal artery: Report of a case and review of the literature . Am J Clin Pathol 45:472-479, 1966. 3. Foord AG, Lewis RD: Primary dissecting aneurysms of peripheral and pulmonary arteries: Dissecting hemorrhage of media . Arch Pathol 68:553-577, 1959. 4. Gilfillan RS, Smart WR, Bostwick WL: Dissecting aneurysm of the renal artery . Arch Surg 73:737-740, 1956.Crossref 5. Grablowsky OM, Weichert RF III, Goff JB, et al: Renal artery thrombosis following blunt trauma: Report of four cases . Surgery 67:895-900, 1970. 6. Guthrie W, Maclean H: Dissecting aneurysms of arteries other than the aorta . J Pathol 108:219-235, 1972.Crossref 7. Hare WSC, Kincaid-Smith P: Dissecting aneurysm of the renal artery . Radiology 97:255-263, 1970.Crossref 8. Harrison EG Jr, Hunt JC, Bernatz PE: Morphology of fibromuscular dysplasis of the renal artery in renovascular hypertension . Am J Med 43:97-117, 1967.Crossref 9. Henry L, Burke WD: Isolated dissecting aneurysms of the renal artery . Angiology 14:269-276, 1963.Crossref 10. Kauffman JJ, Coulson WF, Lecky JW, et al: Primary dissecting aneurysm of renal artery: Report of a case causing reversible renal hypertension . Ann Surg 177:259-263, 1973.Crossref 11. Khanna OP, Nedwick A, Gonick A: Accelerated hypertension due to intramural dissection of accessory renal artery . Urology 1:130-133, 1973.Crossref 12. Liebow IM, Cline T, Post RS, et al: Isolated bilateral simultaneous dissection of the renal arteries . Am J Med 21:151-156, 1956.Crossref 13. Meyers DS, Grim CE, Keitzer WF: Fibromuscular dysplasia of the renal artery with medial dissection: A case simulating polyarteritis nodosa . Am J Med 56:412-416, 1974.Crossref 14. Neuman HW, Sakin AF: Unilateral dissecting aneurysm of the renal artery . Can J Surg 8:291-295, 1965. 15. Perry MO: Hypertension and dissecting aneurysms of the renal artery . Arch Surg 102:216-217, 1971.Crossref 16. Rosenblum WI: Isolated dissecting aneurysm of the renal artery . J Urol 95:135-138, 1966. 17. Skinner DG: Traumatic renal artery thrombosis: A successful thrombectomy and revascularization . Ann Surg 177:264-267, 1973.Crossref 18. Stables DP, Fouche RF, DeVilliers Van Neiker JP, et al: Traumatic renal artery occlusion: Twenty-one cases . J Urol 115:229-233, 1976. 19. Tuqan NA: Primary dissecting aneurysm of the renal artery . J Pathol Bacteriol 89:369-370, 1965.Crossref 20. Wadhwani IB, Johenning PW, Jawa PS: Unusual sequelae following blunt trauma to renal pedicle . Urology 3:79-81, 1974.Crossref 21. Watson AJ: Dissecting aneurysms of arteries other than the aorta . J Pathol Bacteriol 72:439-449, 1956.Crossref 22. Wheat MW Jr, Palmer RF: Dissecting aneurysms of the aorta . Curr Probl Surg , (July) , 1971. 23. Prokop EK, Wheat MW Jr, Palmer RF: Hydrodynamic forces in dissecting aneurysms . Circ Res 27:121-127, 1970.Crossref 24. Spencer MP, Dennison AB: Pulsatile blood flow in the vascular system , in Hamilton WR (ed): Handbook of Physiology . Washington, DC, American Physiological Society, 1963, vol 2, pp 839-864. 25. Lim RC Jr, Eastman AB, Blaisdell FW: Renal autotransplantation: Adjunct to repair of renal vascular lesions . Arch Surg 105:847-852, 1972.Crossref 26. Collins HA, Jacobs JK: Acute arterial injuries due to blunt trauma . J Bone Joint Surg 43A:193-196, 1961. 27. Ross R, Ackerman E, Pierce JM: Traumatic subintimal hemorrhage of the renal artery . J Urol 104:11-13, 1970. 28. Caponegro PJ, Leadbetter GW: Traumatic renal artery thrombosis . J Urol 109:769-771, 1973. 29. Evans A, Mogg RA: Renal artery thrombosis due to closed trauma . J Urol 105:330-334, 1971. 30. Sturm JT, Perry JF, Cass AS: Renal artery and vein injury following blunt trauma . Ann Surg 182:696-698, 1975.Crossref 31. Itzchak Y, Adar R, Moses M, et al: Occlusion of renal and visceral arteries following blunt abdominal trauma: Angiographic observations . J Cardiovasc Surg 15:383-388, 1974. 32. Morse TS, Harris BH: Nonpenetrating renal vascular injuries . J Trauma 13:497-501, 1973.Crossref 33. Marks LS, Brosman SA, Lindstrom RR, et al: Arteriography in penetrating renal trauma . Urology 3:18-22, 1974.Crossref 34. Flaster SL, Bush IM: The use of intraoperative renal arteriography in evaluating renal injuries . J Urol 109:763-765, 1973. 35. Guerrier K, Albert DJ, Mahoney SA, et al: Delayed nephrectomy after trauma . J Trauma 9:465-469, 1969.Crossref 36. Jacdo ET, Reisin E, Golan M, et al: Ex situ renal artery angioplasty followed by heterotropic autotransplantation of kidney in renal arterial thrombosis . Vase Surg 7:238-246, 1973.Crossref 37. Fay R, Brosman S, Lindstrom R, et al: Renal artery thrombosis: A successful revascularization by autotransplantation . J Urol 111:572-576, 1974. 38. Bergentz SE, Faarup P, Hegedus V, et al: Diagnosis of hypertension due to occlusion of a supplemental renal artery; its localization, treatment by removal from the body, microsurgical repair and reimplantation: A case report . Ann Surg 178:643-647, 1973.Crossref 39. Stanley JC, Gewertz BL, Bove EL, et al: Arterial fibrodysplasia: Histopathologic character and current etiologic concepts . Arch Surg 110:561-566, 1975.Crossref 40. McCormack LJ, Poutasse EF, Meaney TF, et al: A pathologic-arteriographic correlation of renal arterial disease . Am Heart J 72:188, 1966.Crossref 41. Reich SB, Riley JC III, Christopher RA, et al: Changes in pulse wave form with flow through vessels with repetitive saccular dilatations and stenosis . Invest Radiol 10:622-626, 1975.Crossref 42. Flanigan DP, Tullis JP, Streeter VL, et al: Multiple subcritical arterial stenoses: Effect on poststenotic pressure and flow. Ann Surg. to be published. 43. Nalbandian RM, Chason JL: Intramural (intramedial) dissecting hematomas in normal and otherwise unremarkable coronary arteries . Am J Clin Pathol 43:348-356, 1965. 44. Stanley JC, Rhodes EL, Gewertz BL, et al: Renal artery aneurysms: Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilatations . Arch Surg 110:1327-1333, 1975.Crossref 45. Ehrenfeld WK, Wylie EJ: Spontaneous dissection of the internal carotid artery . Arch Surg 111:1294-1301, 1976.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1977

References