Suprarenal

BACKGROUND: Supra aortic obstruction in children is uncommon and is seen in certain unique conditions. While intraluminal obstruction due to heavy calcification is seen in older populations, it is not described in pediatric populations. The coral reef aorta is a rare and distinct calcifying disease causing luminal obstruction of the suprarenal aorta in adults. The definition of this diagnosis relies entirely on the unique aspects and consistency of the lesions, which are rock-hard, irregular, gritty plaques with a white luminal surface resembling a coral reef...

OBJECTIVES: The aim of this study was to assess whether the ratio of the mean infrarenal neck diameter to the suprarenal aortic diameter is a predictor for a durable proximal seal after endovascular aneurysm repair (EVAR). METHODS: A total of 439 patients who underwent elective EVAR between 2004 and 2018 in a single vascular referral center met our inclusion criteria. Ratios were calculated by dividing the mean infrarenal neck diameter by 4 different suprarenal aortic diameters...

An adult male in his early 30s diagnosed with multiple endocrine neoplasia type 2A syndrome, confirmed through genetic testing, presented as bilateral pheochromocytoma in a metachronous fashion, primary hyperparathyroidism and medullary thyroid carcinoma. Left and right adrenalectomy was done 9 years and 3 years ago, respectively. He was also subjected to total thyroidectomy with neck dissection and left inferior parathyroidectomy. During surveillance monitoring, 24-hour total urine metanephrines were elevated 13...

Ovarian cancer (OC), the most lethal gynecological malignancy, usually presents in advanced stages. Characterized by peritoneal and lymphatic dissemination, OC necessitates a complex surgical approach usually involving the upper abdomen with the aim of achieving optimal cytoreduction without visible macroscopic disease (R0). Failures in optimal cytoreduction, essential for prognosis, often stem from overlooking anatomical neglected sites that harbor residual tumor. Concealed OC metastases may be found in anatomical locations such as the omental bursa; Morison's pouch; the base of the round ligament and hepatic bridge; the splenic hilum; and suprarenal, retrocrural, cardiophrenic and inguinal lymph nodes...

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PURPOSE: Renal metabolic rate of oxygen (rMRO2 ) is a potentially important biomarker of kidney function. The key parameters for rMRO2 quantification include blood flow rate (BFR) and venous oxygen saturation (SvO2 ) in a draining vessel. Previous approaches to quantify renal metabolism have focused on the single organ. Here, both kidneys are considered as one unit to quantify bilateral rMRO2 . A pulse sequence to facilitate bilateral rMRO2 quantification is introduced. METHODS: To quantify bilateral rMRO2 , measurements of BFR and SvO2 are made along the inferior vena cava (IVC) at suprarenal and infrarenal locations...

PURPOSE: To describe the semibranch as new tool to treat patients with thoracoabdominal, para- and juxtarenal aortic pathologies. TECHNIQUE: The technique is demonstrated in 2 patients with aortic pathologies. First, a 76-year-old woman with a type Ia endoleak after endovascular repair of abdominal aneurysm (EVAR). Due to the short mainbody of the EVAR and suprarenal extension of the pathology, a 4-branched device with integrated bifurcation was chosen. To realize a branched device in small diameters of the suprarenal aorta, 2 semibranches, for the superior mesenteric artery (SMA) and the celiac trunc (CT), were planned...

New-onset acute type B aortic dissection after prior endovascular aneurysm repair is extremely rare. Extension of an aortic dissection can cause destabilization of the previously implanted stent graft, thrombosis of the stent graft, and rupture of the aneurysmal sac, with high mortality without therapy. This report describes the case of a 66-year-old patient complaining of sudden abdominal pain radiating to both flanks. Computed tomography angiography of the aorta revealed acute type B aortic dissection with infrarenal rupture of the false lumen after endovascular abdominal aneurysm repair 5 years prior...

Congenital anomalies of inferior vena cava are increasingly being recognized with the technical advancements and increased utilization of cross-sectional imaging techniques. Duplication of inferior vena cava classically involves duplication of the infrarenal segment, where both inferior vena cava ascend on either side of the abdominal aorta until they form a confluence at the level of the renal veins. It has been extensively described in literature with few reports of more complex variation in the form of duplicated infrarenal inferior vena cava with azygos or hemiazygos continuation...

Transaortic thromboendarterectomy and bypass have been the conventional treatment for coral reef aortic occlusions but are associated with significant mortality, morbidity and reintervention rate since these patients often present with heart failure, uncontrolled hypertension and renal dysfunction. Endovascular treatment has not become popular because of fear of aortic rupture and visceral ischemia. We present our experience with endovascular management of 10 patients with coral reef aorta. Uncontrolled hypertension, chronic renal disease, disabling claudication, and critical limb ischemia with tissue loss were the presenting symptoms...

Aortic dissection occurs when a weakened portion of the intima tears, and a separation of layers propagates along the aortic wall to form a false lumen filled with active blood flow or intramural thrombus. The unpredictable nature of aortic dissection formation and need for immediate intervention leaves limited serial human image data to study the formation and morphological changes that follow dissection. We used volumetric ultrasound examination, histology, and scanning electron microscopy (SEM) to examine intramural thrombi at well-defined timepoints after dissection occurs in apolipoprotein E-deficient mice infused with angiotensin II (n = 71)...

OBJECTIVE: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA). METHODS: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023)...

OBJECTIVES: The current report describes the combined unusual origin of the left inferior phrenic and left gastric arteries observed during a routine dissection of the upper abdominal region. BACKGROUND: The branches of the abdominal aorta are important vessels that supply blood to various organs and structures in the abdominal cavity. While there is typically a common pattern of branching, anatomical variations can occur, leading to differences in the branching patterns of the abdominal aorta...

Variations in the pattern of urogenital vessels can arise as a single occurrence or as a combination, which may increase the risk of unexpected injury during surgical procedures. Multiple variations in the renal and testicular vessels, in a novel combination, were observed during dissection of an 87-year-old Japanese male cadaver. In the present case, the patient had two renal arteries on each side. On the right side, the superior and inferior renal arteries emerged from the abdominal aorta at the L1 and L4 vertebrae levels, respectively...

PURPOSE: In this study, we examined the safety and effectiveness of removing inferior vena cava (IVC) filters with residual acute thrombosis after endovascular therapy. METHODS: A retrospective chart review of 712 patients who underwent retrievable IVC filter implantation between July 2018 and December 2022 was conducted. Residual thrombosis with the IVC filter occurred in 18 patients, and the volume of residual acute thrombosis in the IVC filter exceeded 1 mL in all cases...

The rupture of an abdominal aortic aneurysm (AAA) causes about 200,000 deaths worldwide each year. However, there are currently no effective drug therapies to prevent AAA formation or, when present, to decrease progression and rupture, highlighting an urgent need for more research in this field. Increased vascular inflammation and enhanced apoptosis of vascular smooth muscle cells (VSMCs) are implicated in AAA formation. Here, we investigated whether hydralazine, which has anti-inflammatory and anti-apoptotic properties, inhibited AAA formation and pathological hallmarks...

Pheochromocytomas are rare tumors that arise from the sympathetic ganglia or adrenal medulla and secrete catecholamines that are known for the classic triad of headaches, profuse sweating, and paroxysmal hypertension. However, there have been instances of asymptomatic patients found to have a pheochromocytoma. Adrenal incidentalomas are accidentally discovered through radiologic imaging, and subsequent testing can confirm a pheochromocytoma. Here, we present a case of a 67-year-old female found to have an adrenal incidentaloma on kidney ultrasound (US) after presenting to the emergency room (ER) due to nausea...

T-lymphoblastic lymphoma is the most common lymphoblastic lymphoma in children, and often presents with a mediastinal mass. Lymphomatous suprarenal masses are possible but rare. Here we discuss the case of a previously healthy 3-year-old male who presented with mediastinal T-lymphoblastic lymphoma (T-LLy) with bilateral suprarenal masses. Following initial treatment, surgical biopsy of persisting adrenal masses revealed bilateral neuroblastoma (NBL). A clinical genetics panel for germline cancer predisposition did not identify any pathogenic variants...

AIM: To analyse the clinicoradiological characteristics of traumatic inferior vena cava (IVC) injury level on preoperative computed tomography (CT). MATERIALS AND METHODS: This retrospective study evaluated patients from a single trauma centre treated for traumatic IVC injury between January 2014 and January 2021. Data on demographics, mechanism of injury, Injury Severity Score, radiological findings on CT and angiography, IVC injury level in surgical findings, complications, and clinical outcomes were collected...

A 13-year-old was admitted to our clinic complaining about a vision loss of over 2 weeks. Bilateral optic disc edema, peripapillary flame-shaped hemorrhages, macular star pattern exudates, and cotton wool spots were found in fundoscopic examination. The OCT exam showed bilaterally serous retinal detachments in sub-foveal region with intraretinal exudates. A pediatric examination found a high systemic hypertension of 230/140 mm Hg, and laboratory tests revealed increased levels of plasmatic and urinary catecholamines...