ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.357 |
Resumo: | Introduction: Acute renal ischemia has a low incidence. Literature evidence of its surgical treatment is based on case series, and there are no well-defined indications for renal revascularization in this setting. Methods: Observational and retrospective study, based on clinical records from patients that underwent renal artery revascularization due to acute renal ischemia, at a tertiary university hospital, from January 2011 to June 2020. Primary endpoint was 30 days dialysis rate, and secondary endpoints were 30 days de novo chronic kidney disease rate and 30 days survival. Results: Eleven patients with acute renal ischemia were included. The causes of renal artery occlusion were: aortic dissection (N=3), native renal artery thrombosis (N=3), thrombosis of a previously revascularized renal artery (N=3), embolism (N=1) and closed trauma (N=1). Two of these affected patients with a single kidney. The median time from symptom onset to surgical revascularization was 24 hours. Two patients had previously known chronic kidney disease. Clinical presentation was lumbar or abdominal pain (n=8), non-controlled hypertension (N=5), or oligoanuria (N=5). The diagnosis was made by CTA in all patients. In all cases, the main renal artery was involved (N=9 from its ostium), and there was some degree of affected kidney contrast enhancement. Unilateral endovascular revascularization was performed with angiographic success in 10 patients; it was performed a bilateral endovascular revascularization in one of the three patients who had bilateral renal ischemia. Except for one patient with stent occlusion (that underwent DCB angioplasty), all patients underwent stent angioplasty (6 using covered stents). Two patients presented postoperative oligoanuria, and four required at least one dialysis session. At 30 days, the rate of dialysis was 11% (one patient with traumatic bilateral acute renal ischemia with 13 hours evolution), and the percentage of de novo chronic kidney disease was 22%. The 30-day survival was 90%. Conclusion: In this population, we can foresee the reversion of acute renal ischemia, even after prolonged renal artery occlusions. However, with our data, it is not possible to predict which patients will recover previous renal function after urgent revascularization with angiographic success. For being prompt and less invasive, endovascular treatment is the first surgical option for acute renal ischemia treatment at our institution. |
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ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTIONISQUEMIA AGUDA RENAL, UMA EMERGÊNCIA CIRÚRGICA VASCULAR COM EVOLUÇÃO AINDA DESCONHECIDAAcute renal ischemiaRenal artery occlusionRenal artery revascularizationStent angioplastyIsquemia renal agudaOclusão da artéria renalRevascularização da artéria renalAngioplastia com stentIntroduction: Acute renal ischemia has a low incidence. Literature evidence of its surgical treatment is based on case series, and there are no well-defined indications for renal revascularization in this setting. Methods: Observational and retrospective study, based on clinical records from patients that underwent renal artery revascularization due to acute renal ischemia, at a tertiary university hospital, from January 2011 to June 2020. Primary endpoint was 30 days dialysis rate, and secondary endpoints were 30 days de novo chronic kidney disease rate and 30 days survival. Results: Eleven patients with acute renal ischemia were included. The causes of renal artery occlusion were: aortic dissection (N=3), native renal artery thrombosis (N=3), thrombosis of a previously revascularized renal artery (N=3), embolism (N=1) and closed trauma (N=1). Two of these affected patients with a single kidney. The median time from symptom onset to surgical revascularization was 24 hours. Two patients had previously known chronic kidney disease. Clinical presentation was lumbar or abdominal pain (n=8), non-controlled hypertension (N=5), or oligoanuria (N=5). The diagnosis was made by CTA in all patients. In all cases, the main renal artery was involved (N=9 from its ostium), and there was some degree of affected kidney contrast enhancement. Unilateral endovascular revascularization was performed with angiographic success in 10 patients; it was performed a bilateral endovascular revascularization in one of the three patients who had bilateral renal ischemia. Except for one patient with stent occlusion (that underwent DCB angioplasty), all patients underwent stent angioplasty (6 using covered stents). Two patients presented postoperative oligoanuria, and four required at least one dialysis session. At 30 days, the rate of dialysis was 11% (one patient with traumatic bilateral acute renal ischemia with 13 hours evolution), and the percentage of de novo chronic kidney disease was 22%. The 30-day survival was 90%. Conclusion: In this population, we can foresee the reversion of acute renal ischemia, even after prolonged renal artery occlusions. However, with our data, it is not possible to predict which patients will recover previous renal function after urgent revascularization with angiographic success. For being prompt and less invasive, endovascular treatment is the first surgical option for acute renal ischemia treatment at our institution.Introdução: A incidência de isquemia aguda renal é baixa. A experiência publicada do seu tratamento cirúrgico resume-se a séries de casos e não há indicações bem definidas para a revascularização renal em caso de isquemia aguda. Métodos: Estudo observacional retrospetivo realizado com base na consulta de processos clínicos de doentes submetidos a revascularização de artéria renal por isquemia aguda renal, num hospital universitário terciário, de Janeiro de 2011 a Junho de 2020. O endpoint primário foi a taxa de diálise aos 30 dias e os endpoints secundários foram a taxa de doença renal crónica de novo aos 30 dias e a sobrevida aos 30 dias. Resultados: Foram incluídos 11 doentes com isquemia aguda renal. As causas da oclusão arterial renal foram: disseção aórtica (N=3), trombose de artéria renal nativa (N=3), trombose de revascularização renal prévia (N=3), embolia (N=1) e trauma fechado (N=1). Dois dos casos corresponderam a doentes com rim único. A mediana de tempo desde o início do quadro até à revascularização cirúrgica foi de 24 horas. Dois doentes apresentavam doença renal crónica prévia conhecida. A apresentação clínica foi de dor lombar ou abdominal (n=8), HTA não controlada (N=5) e/ou oligoanúria (N=5). O diagnóstico foi realizado em todos com recurso a angio-TC. Em todos os doentes, a artéria renal principal estava afetada (N=9 desde o seu óstio) e havia algum grau de captação de contraste pelo rim afetado. Em todos os casos, foi realizada a revascularização unilateral de uma artéria renal com sucesso angiográfico, com exceção de um dos três casos em que a isquemia renal era bilateral, em que ambas as artérias renais ocluídas foram revascularizadas. Com exceção de um doente com oclusão de stent (submetido a angioplastia com DCB), todos foram submetidos a angioplastia com stent (6 com stents cobertos). Dois doentes apresentaram oligoanúria no pós-operatório e quatro necessitaram de pelo menos uma sessão dialítica. Aos 30 dias, a taxa de diálise foi de 11% (doente com isquemia aguda renal bilateral de etiologia traumática com 13 horas de evolução) e a taxa de doença renal crónica de novo de 22%. A sobrevida aos 30 dias foi de 90%. Conclusão: Nesta população de doentes, pode-se verificar a reversão da isquemia aguda renal mesmo após oclusões prolongadas das artérias renais. No entanto, com os dados disponíveis, não é possível anteceder quais os doentes que recuperarão a função renal prévia após revascularização urgente com sucesso angiográfico. Por ser rápido e pouco invasivo, o tratamento endovascular é a primeira linha no tratamento cirúrgico da isquemia aguda renal na nossa instituição. Sociedade Portuguesa de Angiologia e Cirurgia Vascular2021-06-02T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.357oai:ojs.acvjournal.com:article/357Angiologia e Cirurgia Vascular; Vol. 17 No. 1 (2021): March; 7-12Angiologia e Cirurgia Vascular; Vol. 17 N.º 1 (2021): Março; 7-122183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/357https://doi.org/10.48750/acv.357http://acvjournal.com/index.php/acv/article/view/357/228Copyright (c) 2021 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCorreia, Ricardo AndréCatarino, JoanaVieira, IsabelBento, RitaGarcia, RitaPais, FábioRibeiro, TiagoCardoso, JoanaFerreira, RitaGarcia, AnaGonçalves, Frederico BastosFerreira, Maria Emília2022-05-23T15:10:11Zoai:ojs.acvjournal.com:article/357Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:42.880874Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION ISQUEMIA AGUDA RENAL, UMA EMERGÊNCIA CIRÚRGICA VASCULAR COM EVOLUÇÃO AINDA DESCONHECIDA |
title |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION |
spellingShingle |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION Correia, Ricardo André Acute renal ischemia Renal artery occlusion Renal artery revascularization Stent angioplasty Isquemia renal aguda Oclusão da artéria renal Revascularização da artéria renal Angioplastia com stent |
title_short |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION |
title_full |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION |
title_fullStr |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION |
title_full_unstemmed |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION |
title_sort |
ACUTE RENAL ISCHEMIA, A SURGICAL VASCULAR EMERGENCE WITH A STILL UNKNOWN EVOLUTION |
author |
Correia, Ricardo André |
author_facet |
Correia, Ricardo André Catarino, Joana Vieira, Isabel Bento, Rita Garcia, Rita Pais, Fábio Ribeiro, Tiago Cardoso, Joana Ferreira, Rita Garcia, Ana Gonçalves, Frederico Bastos Ferreira, Maria Emília |
author_role |
author |
author2 |
Catarino, Joana Vieira, Isabel Bento, Rita Garcia, Rita Pais, Fábio Ribeiro, Tiago Cardoso, Joana Ferreira, Rita Garcia, Ana Gonçalves, Frederico Bastos Ferreira, Maria Emília |
author2_role |
author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Correia, Ricardo André Catarino, Joana Vieira, Isabel Bento, Rita Garcia, Rita Pais, Fábio Ribeiro, Tiago Cardoso, Joana Ferreira, Rita Garcia, Ana Gonçalves, Frederico Bastos Ferreira, Maria Emília |
dc.subject.por.fl_str_mv |
Acute renal ischemia Renal artery occlusion Renal artery revascularization Stent angioplasty Isquemia renal aguda Oclusão da artéria renal Revascularização da artéria renal Angioplastia com stent |
topic |
Acute renal ischemia Renal artery occlusion Renal artery revascularization Stent angioplasty Isquemia renal aguda Oclusão da artéria renal Revascularização da artéria renal Angioplastia com stent |
description |
Introduction: Acute renal ischemia has a low incidence. Literature evidence of its surgical treatment is based on case series, and there are no well-defined indications for renal revascularization in this setting. Methods: Observational and retrospective study, based on clinical records from patients that underwent renal artery revascularization due to acute renal ischemia, at a tertiary university hospital, from January 2011 to June 2020. Primary endpoint was 30 days dialysis rate, and secondary endpoints were 30 days de novo chronic kidney disease rate and 30 days survival. Results: Eleven patients with acute renal ischemia were included. The causes of renal artery occlusion were: aortic dissection (N=3), native renal artery thrombosis (N=3), thrombosis of a previously revascularized renal artery (N=3), embolism (N=1) and closed trauma (N=1). Two of these affected patients with a single kidney. The median time from symptom onset to surgical revascularization was 24 hours. Two patients had previously known chronic kidney disease. Clinical presentation was lumbar or abdominal pain (n=8), non-controlled hypertension (N=5), or oligoanuria (N=5). The diagnosis was made by CTA in all patients. In all cases, the main renal artery was involved (N=9 from its ostium), and there was some degree of affected kidney contrast enhancement. Unilateral endovascular revascularization was performed with angiographic success in 10 patients; it was performed a bilateral endovascular revascularization in one of the three patients who had bilateral renal ischemia. Except for one patient with stent occlusion (that underwent DCB angioplasty), all patients underwent stent angioplasty (6 using covered stents). Two patients presented postoperative oligoanuria, and four required at least one dialysis session. At 30 days, the rate of dialysis was 11% (one patient with traumatic bilateral acute renal ischemia with 13 hours evolution), and the percentage of de novo chronic kidney disease was 22%. The 30-day survival was 90%. Conclusion: In this population, we can foresee the reversion of acute renal ischemia, even after prolonged renal artery occlusions. However, with our data, it is not possible to predict which patients will recover previous renal function after urgent revascularization with angiographic success. For being prompt and less invasive, endovascular treatment is the first surgical option for acute renal ischemia treatment at our institution. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-02T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.357 oai:ojs.acvjournal.com:article/357 |
url |
https://doi.org/10.48750/acv.357 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/357 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/357 https://doi.org/10.48750/acv.357 http://acvjournal.com/index.php/acv/article/view/357/228 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 17 No. 1 (2021): March; 7-12 Angiologia e Cirurgia Vascular; Vol. 17 N.º 1 (2021): Março; 7-12 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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