RU2657933C1 - Method of selective collection of blood from the renal veins with abnormalities of blood supply to the kidney - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to X-ray surgical methods of diagnosis and treatment. Perform puncture of the right femoral arteries and veins with the installation of introducers with a diameter of 5F or 6F in these vessels. Then a diagnostic catheter is injected into the lumen of the inferior vena cava. In the aortic lumen, a diagnostic catheter is also set up, which is installed in the mouth of an additional renal artery. Then, in the process of selective angiography, an X-ray contrast preparation is introduced into the lumen of the additional renal artery in an amount of 15–20 ml before contrasting the microcapillary network of the kidney with subsequent observation of the venous phase and contrasting of the additional renal vein, including its place of confluence in the lower vena cava. Focusing on the received video image, a diagnostic catheter in the inferior vena cava is placed in the mouth of an additional vein. Contrast is repeated to control the location of the catheter at the mouth of the accessory vein, after which venous blood is taken from it. Then, venous blood is taken from the primary renal vein. Above sequence of operations is repeated on the contralateral kidney. Then both catheters are removed, the intradusers are removed and hemostasis is performed.

EFFECT: method allows to provide selective blood sampling from an additional renal vein that drains blood from that part of the kidney, which is supplemented with an additional renal artery, thereby increasing the accuracy of the diagnostic study.

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Description

The invention relates to medicine, namely to x-ray surgical methods of diagnosis and treatment, and allows for selective blood sampling from an additional renal vein that takes blood only from that part of the kidney that is supplied with an additional renal artery.

It is known that one of the forms of secondary arterial hypertension is vasorenal hypertension, which occurs as a result of renal ischemia due to impaired blood flow through the renal artery during stenosis with an atherosclerotic plaque. Renal ischemia leads to the activation of the renin-angiotensin-aldosterone system, the release of renin into the blood and increased arterial hypertension. However, according to the results of studies, in some cases, the cause of activation of the renin-angiotensin-aldosterone system may also be anomalies in the blood supply to the kidney, in particular the presence of an additional renal artery [2, 5, 6]. This leads to a redistribution of blood flow and ischemia of a small area of the kidney, which is supplied by the additional renal artery. This variant of arterial hypertension is treated surgically by resection of the putative ischemic region of the kidney [1, 4, 7]. However, evidence of impaired blood flow in this segment of the kidney is extremely difficult, because blood sampling from a peripheral vein or from a common renal vein to determine the level of renin may be uninformative, and radiation methods do not allow an accurate determination of the ischemic section of renal tissue [8]. To improve the quality of diagnosis and treatment, we have proposed the following method of selective blood sampling from an additional renal vein, which takes blood only from that part of the kidney that is supplied with an additional renal artery.

The basis of the invention is the creation of a method of selective blood sampling from additional renal veins, which provides improved diagnosis of vasorenal hypertension in case of anomalies in the blood supply to the kidney by identifying an ischemic site in the kidney, as well as determining its size and location.

The solution to this problem is provided by the fact that in the method of selective blood sampling from the renal veins with anomalies in the blood supply to the kidneys, the right femoral arteries and veins are punctured with the introduction of introducers of introducers 5F or 6F in diameter, then a diagnostic catheter is inserted into the lumen of the inferior vena cava, into the aortic lumen a diagnostic catheter is also inserted, which is installed at the mouth of the additional renal artery, then, during selective angiography, an radiopaque pre-insertion is introduced into the lumen of the additional renal artery arat in an amount of 15-20 ml and kidney contrast microcapillary network, followed by observation of the venous phase contrast and additional renal vein, including its confluence in the inferior vena cava; being guided by the received video image, a diagnostic catheter in the inferior vena cava is installed at the mouth of the accessory vein; the contrast is repeated to control the location of the catheter at the mouth of the accessory vein, after which venous blood is taken from it; then venous blood is drawn from the main renal vein and the above sequence of actions is repeated on the contralateral kidney, after which both catheters are removed, the introducers are removed and hemostasis is performed.

The invention is illustrated in FIG. 1-3. In FIG. 1 shows selective angiography of the left incremental renal artery, arterial phase. In FIG. Figure 2 shows the selective angiography of the left additional renal artery, venous phase (the place where the additional renal vein flows into the inferior vena cava) is visualized. In FIG. Figure 3 demonstrates the ability to control the position of the catheter for venous blood sampling in the lumen of the extra renal vein.

The presence of an additional renal artery is sometimes accompanied by the development of vasorenal hypertension due to redistribution of blood flow and the development of ischemia of a small area of renal tissue, which in turn activates renin production by an ischemic site and, as a result, triggers a mechanism for increasing blood pressure.

When determining the concentration of blood renin from a peripheral vein, the analysis result may be within normal limits, which leads to a false idea about the genesis of arterial hypertension and the wrong treatment tactics for the patient. For an accurate diagnosis, it is necessary to perform a selective blood sampling from a vein that removes blood from an ischemic kidney site. However, when it comes to the organ site supplied with the additional artery, finding the mouth of the additional renal vein is very problematic due to the altered anatomy and the absence of a typical place where the additional renal vein flows into the inferior vena cava. To determine the mouth of the extra renal vein, we proposed the following method.

Clinical example

Patient S. 32 years old was treated with a diagnosis of arterial hypertension. The examination revealed an additional renal artery of the left kidney. In order to selectively take blood from the renal veins and determine the level of renin, the patient was taken to an X-ray. A puncture of the right femoral artery and vein is performed with the introduction of introducers of 6 F and 5 F introducers into these vessels. A diagnostic catheter is inserted into the lumen of the inferior vena cava with the help of which selective blood sampling is planned, a diagnostic catheter is inserted into the aortic lumen and inserted into the mouth of the additional renal artery. Then, when shooting a film in the X-ray mode, a 15-20 ml radiopaque preparation is introduced into the lumen of the additional renal artery until the kidney microcapillary network is confidently contrasted (Fig. 1), followed by observation of the venous phase and contrast of the additional renal vein, including its place where it flows into the lower vena cava (Fig. 2). Then the shooting of the film in the radiography mode is terminated. Based on the received video image, a diagnostic catheter in the inferior vena cava is placed at the mouth of the accessory vein. According to the previously described mechanism, the catheter is located at the mouth of the accessory vein (Fig. 3 3), after which venous blood is sampled. Then, venous blood is sampled from the main renal vein and the procedure is repeated on the contralateral kidney. Then both catheters are removed, the introducers are removed and hemostasis is performed.

Bibliography

1. Frantsev R.S., Chumakov P.I. Surgical treatment of nephrogenic arterial hypertension with incomplete doubling of the kidney // Modern problems of science and education. 2014. No1. URL: https://www.science-education.ru/en/article/view?id=11930

2. Frantsev R.S., Chumakov P.I., Redko Yu.P. Evaluation of the results of examination of patients with arterial hypertension when choosing the tactics of surgical treatment // Modern problems of science and education. 2015. No5. S. 127.

4. Managadze L.G., Lopatkin N.A., Laurent O. B. and others. Operational urology, classics and innovations. A guide for doctors. R. - M .: Medicine, 2003.S. 63-68.

5. Mukhin N.A., Moiseev S.V., Fomin, V.V. et al. Multiple arteries of the kidneys as a cause of resistant hypertension // Clinical Nephrology. Number 3. 2009.S. 68-72.

6. Pronyaev V.I. Additional and perforating arteries of human kidneys in ontogenesis. Abstract. dis. Cand. honey. sciences. Kiev. 1973

7. Hinman F. Operational Urology: Atlas, 2001. GEOTAR-MED. S. 2019 - 2027.

8. Rundback J.H., Sacks D., Kent K.C., et al. Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. // Circulation. - 2002. - Vol. 106. - P. 1572-1585.

Claims (1)

A method of selective blood sampling from the renal veins with anomalies in the blood supply to the kidney, characterized in that the right femoral arteries and veins are punctured with the introduction of introducers of 5F or 6F diameters into these vessels, then a diagnostic catheter is inserted into the lumen of the inferior vena cava, and a diagnostic catheter is also inserted a catheter, which is installed at the mouth of the additional renal artery, then in the process of selective angiography, an X-ray contrast drug in the amount of 15-20 ml is injected into the lumen of the additional renal artery stirovaniya microcapillary network kidney, followed by observation of the venous phase contrast and additional renal vein, including its confluence in the inferior vena cava; being guided by the received video image, a diagnostic catheter in the inferior vena cava is installed at the mouth of the accessory vein; the contrast is repeated to control the location of the catheter at the mouth of the accessory vein, after which venous blood is taken from it; then venous blood is drawn from the main renal vein and the above sequence of actions is repeated on the contralateral kidney, after which both catheters are removed, the introducers are removed and hemostasis is performed.

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