Name : Morteza
Family :Sanei Taheri
Affiliation : Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree: Associate Professor of Radiology
Resident : Ramin Pourghorban
Gender : Female
Age : 40
A 40 year old female referred for embolization of facial hemangioma and experienced left flank pain during the intervention.
Imaging Procedures and Findings
A 40 year old female referred for embolization of facial hemangioma and experienced left flank pain during the intervention. Angiographic study from left renal artery was done. Selective left renal artery Digital Subtraction Angiogram (images 1-3) demonstrates complete lack of perfusion of lower two thirds of the left kidney during early and late phases of contrast injection. Late abdominal radiograph (image-4) shows the retained contrast medium in the false lumen of iatrogenic branch renal artery dissection. Longitudinal ultrasonographic exam (image-5) reveals well-demarcated increased cortical echogenicity of lower two thirds of the left kidney. However, Color Doppler study (image-6) shows symmetric renal perfusion through the entire renal parenchyma and RI of renal branch arteries in Duplex Doppler examination (not shown) was about 0.6. The patient underwent conservative therapy with Heparin and complete recovery was achieved.
Renal artery dissection may be caused by iatrogenic injury, trauma, or arterial disease including fibromuscular disease, atherosclerotic disease, or connective tissue disorder. Clinical presentation of dissection of the renal artery may be classified as acute or chronic. Acute dissections are classified as spontaneous, iatrogenic, or agonal, whereas chronic dissections are classified as functional and silent. Despite the clinical significance of aortic dissection, there is an ongoing debate with regard to the pathophysiology of the initial damage to the intima. The trigger in aortic dissection is believed to be a tear or hemorrhage in the aortic wall that leads to a separation of the media with potential end-organ damage from propagation of the dissection, and obstruction of the origins of vital vessels such as the mesenteric, renal, or iliac arteries. Studies of the initiating mechanisms of dissection also lead us to consider the factors that determine the extent of the dissection. Treatment of renal artery dissection remains controversial. Surgical intervention is usually suggested for cases with medically uncontrolled hypertension or progressive renal dysfunction, although some authors have observed that medical treatment alone provides blood pressure control. Only a few cases of percutaneous interventional treatment are reported in the literature.
Iatrogenic Branch Renal Artery Dissection
PeynircioÃ„?lu1 B, PiÃ…?kinkaya S, et al. Isolated spontaneous renal artery dissection: diagnosis and endovascular management. Diagn Interv Radiol. 2011; 17(1):101-4.