Abstract:

Introduction: improving the technique of radiofrequency denervation of renal arteries seems to be extremely important for optimizing the effectiveness of lowering blood pressure in patients with resistant arterial hypertension. Our study presents an assessment of the comparison of long-term results of renal artery denervation (RAD) using various techniques and instruments.

Aim: was to compare the use of various techniques for renal artery denervation and to evaluate longterm results in patients with resistant arterial hypertension using various radio frequency catheters.

Materials and methods: in a prospective study, three groups of patients (n = 58) aged 18-85 years with resistant systolic-diastolic arterial hypertension of 1-2 stages were studied: patients underwent denervation of renal arteries by various methods, against background of standardized antihypertensive therapy. In group I (n = 21), denervation was performed only in the proximal segment of the renal artery (before the first bifurcation). In group II (n = 19), ablation was performed both in proximal segment and in branches of the second and third order, as well as in the accessory renal arteries with a diameter of more than 3 mm. The third control group included 18 patients who received only standardized drug antihypertensive therapy.

Results: technical success of the operation was achieved in 100% of cases. According to the 24-hours ambulatory blood pressure monitoring (ABPM) data, the decrease in blood pressure (BP) in group I by the second year of observation was 6,7 mm Hg, p <0,05 for systolic BP (SBP) and ? 2,7 mm Hg, p> 0,05 for diastolic BP (DBP). In the second group, a greater decrease in mean SBP and DBP was recorded: ? 9,2 mm Hg, p <0,05 and ? 4,3 mm Hg, p <0,05, respectively. In the control group of drug treatment, the weakest antihypertensive effect of treatment was revealed. The average indicators of SBP and DBP decreased by - 4,9/1,9 mm Hg, p> 0,05.

Conclusion: results of the use of prolonged radiofrequency denervation of the main, segmental and accessory renal arteries with a large number of ablation points demonstrate a similar safety and greater efficacy in treatment of patients with resistant arterial hypertension, in comparison with denervation of only main trunk of renal artery.

References 

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Abstract

Recently, there has been a steady tendency to expand indications for organpreserving operations for kidney tumors.The success of the operation depends on many factors and, first of all, on the completeness of tumor removal and reliability of hemostasis without damage to the blood supply of the entire organ with a minimum time of thermal or cold ischemia. Particularly difficult for surgeon are tumors with intrarenal arrangement. This is due to difficulties of intraoperative determination of tumor localization, as well as technical aspects of removal of big newgrowth with the implementation of adequate hemostasis in the bed of the removed tumor. If resection of kidney poles with a tumor is a fairly simple operation, the enucleation of the latter in the depth of the parenchyma at the location in the middle segments of the kidney and in direct contact with large vessels, is of great technical complexity As a rule, central location of intrarenal tumor requires the "exposure" of kidney parenchyma by a separate incision, up to the sectional. The surgeon's task is to minimize such transparenchymal access, which creates difficulties with hemostasis in a limited space and time limit of thermal ischemia. Hemostatic insufficiency, in turn, can lead to postoperative bleeding, and formation of arteriovenous fistulas. Superselective embolization of branches of the renal artery supplying the intrarenal tumor ensures the subsequent optimal revision of the bed of the removed tumor, minimizes blood loss and allows to refuses blood flow arrest of entire organ.

Case report: article presents data of a young 33-year-old patient with a congenital anomaly in the blood supply of left kidney in the form of a multiple renal artery and kidney tumor T1AN0M0. Ultrasound, CT and MRI revealed an intraparenchymal tumor of the left kidney measuring 2,3x2,5x2,2 cm, with blood supply by 4 arteries extending from the aorta. As the first stage, superselective embolization of tumor's blood supplying artery with PVA 355-500 microns was performed. The second stage was the enucleation of a tumor of left kidney under the control of intraoperative ultrasound without thermal kidney ischemia. Intraoperative blood loss less than 150 ml. The patient was discharged on the 7th day

Conclusion: performing selective embolization of the renal artery feeding the tumor makes it possible to perform the operation without thermal ischemia of the kidney with minimal blood loss.

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Abstract:

Aim. Was to investigate phase-parameters of renal arteries blood flow in hypertensive patients.

Material and methods. We have examined 173 patients with arterial hypertension, aged 38-78 years, including associated ischemic heart disease or heart stroke in the past. Control group consisted of 27 almost healthy patients aged 39-76 yrs. Acceleration phase index AT/RR, systolic phase index ET/R-R, and flow propagation index RA/R-R (RA is the time from R wave of ECG to the beginning of the systolic flow in the main renal artery at the hilus of kidney) were derived from the Doppler ultrasound.

Results and conclusions. Acceleration phase index in hypertensive patients was higher and systolic phase index was lower than in healthy subjects. Changing in the phase parameters of renal flow depends on associated clinical conditions. The most expressed changes occur in hypertensive patients with old myocardial infarction. Correlations between the phase parameters, the age and the serum lipids were analyzed. Age dependent normal values of the phase indices of renal flow were established. 

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Abstract:

Article describes the clinical case of a patient suffering from Takayasu's disease and stenotic lesion of the renal artery with early restenosis of renal artery after stenting, causes of mistakes in diagnosis and choice of treatment are also discussed.

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