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Renal Arteriography in Experimental Renal Vein Occlusion

1966; Radiological Society of North America; Volume: 86; Issue: 5 Linguagem: Inglês

10.1148/86.5.851

1527-1315

P. Ruben Koehler, William T. Bowles, William H. McAlister,

Organ Donation and Transplantation

Renal vein thrombosis is a serious disease afflicting mainly children and young adults (5). The condition is frequently not recognized and may be more common than the relatively few documented cases would imply. There is ample experimental data to demonstrate spontaneous recovery from renal vein occlusion (2). The roentgen diagnosis is made rarely and with difficulty. Renal venography is the most direct and accurate way to demonstrate the abnormality but carries the risk of dislodging portions of the thrombus (4, 7). The procedure of percutaneous transrenal venography is not applicable to all patients nor is it always successful (1). It was therefore decided to investigate the feasibility of establishing this diagnosis by means of selective renal arteriography. Crummy and Hipona have previously reported on the value of renal arteriography in renal vein occlusion (3). The results of the experimental work will be presented in a condensed form in this communication. A more detailed discussion of the clinical and roentgen problems of renal vein occlusion will be presented at a later date along with microangiographic, functional, and gross and microscopic observations. Method Eight mongrel dogs were used in this experiment. Unilateral renal vein occlusion was complete in 2 animals, approximately 90 per cent in 2, and 80 per cent in another 2; there were two controls. The degree of occlusion was determined as follows: after the size of the renal vein was assessed at surgery, an appropriate caliber catheter was decided upon and placed against the renal vein. A ligature was placed around the vein and the catheter secured. The catheter was then removed. In one control animal, the arteriograms were carried out in the same manner as in the other dogs but the vein was not occluded. In the other control the vein was completely ligated but no arteriographic studies were performed, in order to be certain that all histopathologic findings were due to the venous occlusion rather than to injected contrast material. Selective renal arteriography with 5 ml of Renografin 60 per cent was performed before occlusion, thirty minutes, twenty-four hours, one week, two weeks, and then monthly for three to six months following occlusion in all dogs. An injection into the aorta was made when the size of the renal artery no longer permitted direct catheterization. All films were exposed in a Schönander film-changer. The following observations were made. I. Complete Occlusion A. Renal Size: The kidney increased rapidly in size within the first twenty-four hours (Graph I). The peak was reached on the one-week examination (Fig. 1, B). Progressive decrease in size occurred over the next one to two months, with stabilization of a small atrophic kidney (Fig. 1, C). B. Renal Artery: Aprogressive decrease in caliber and length of the renal artery followed occlusion (Fig. 1).