Rutherford's 130: Renovascular Disease: Acute Occlusive and Ischemic Events скачать в хорошем качестве

Rutherford's 130: Renovascular Disease: Acute Occlusive and Ischemic Events

#AcuteRenovascularDisease #RenalArteryThrombosis #RenalArteryEmbolism #RenalVeinThrombosis #KidneyIschemia #VascularSurgery #EndovascularTherapy #Rutherford #Diagnosis #Treatment #TimeCritical This summary covers acute renovascular disease, drawing from Rutherford's Vascular Surgery chapters. It focuses on sudden loss of kidney blood supply. Time is critically sensitive; rapid diagnosis and swift treatment are paramount to prevent permanent kidney damage. The duration and severity of reduced blood flow are key factors. Main causes include renal artery thrombosis, embolism, trauma, dissection (aortic or renal artery), iatrogenic injury, and renal vein thrombosis. Much of the evidence comes from case reports and smaller studies, requiring strong clinical judgment. Acute ischemia causes rapid cellular damage and functional loss. Reintroducing blood flow can trigger reperfusion injury, causing further harm. Kidney sensitivity is high; even one hour of warm ischemia can cause significant function loss. Irreversible damage may occur after just 3-4 hours. However, slow blockages may allow collateral vessel development, potentially preserving some function. Good renal vein flow on ultrasound can indicate collateral arterial supply. Renal vein thrombosis also causes acute ischemia through congestion. Symptoms are often non-specific, including abdominal/flank pain, nausea, or decreased urine output, frequently leading to delayed diagnosis. Lab tests are non-definitive; creatinine can be normal in half of cases. Imaging is crucial. CTA is often the primary test for arteries and is gold standard for renal vein thrombosis. MRA is useful if contrast is avoided. Ultrasound is less sensitive but non-invasive. Nuclear scans are highly sensitive but less available acutely. Angiography is mainly used during intervention. Management depends on the cause. Immediate anticoagulation (heparin) is crucial for embolism and thrombosis to prevent further clotting. For embolism, finding/treating the source is vital. Endovascular approaches (thrombolysis, thrombectomy, stenting) are often first-line for embolism and thrombosis/dissection, but open surgery may be necessary if endovascular fails or isn't feasible. Trauma treatment is selective, weighing kidney salvage against other injuries and ischemia time. Renal vein thrombosis treatment is primarily anticoagulation, with intervention reserved for specific severe cases. Outcomes depend heavily on the cause, patient factors, and, critically, the time to restoring blood flow.