Renal stenting

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

Among these 76 patients, 109 bare-coronary stents were deployed in 103 de novo lesions in an equal number of major native epicardial vessels. Patients with in-stent restenosis, bifurcation lesions, vein graft lesions, lesion length of >0.20 mm, acute myocardial infarction in the previous 72 hours, poor left ventricular function (ejection fraction <35%), renal failure defined as creatinine concentration of >2 mg, or under immunosuppressive treatment were excluded from the study. 

Berkompas DC. Abeiximab combined with angioplasty in a patient with renal artery stent subacute thrombosis. Cathet Cardiovasc Diagn 1998 45(3) 272-274. 

Berg R Kaufmann D, van Marrewijk CJ, et al. Spinal cord ischaemia after stent-graft treatment for infra-renal abdominal aortic aneurysms, Analysis of the Eurostar database, Eur J Vase Endovasc Surg 2001 22(4) 342-347. 

From a haemodynamic point of view, the transjugular intrahepatic portosystemic stent shunt (TIPS) constitutes a portacaval side-to-side anastomosis in the form of a nonsurgical link between the portal vein and the hepatic vein. The TIPS can be closely compared with the portacaval interposition shunt, because the pressure reduction also depends on the shunt lumen. Stent placement leads to a permanent decrease in portal pressure, in 60—70% of cases, it was possible to achieve the desired reduction in pressure to almost 12 mm Hg. In addition, the splanchnic blood pool decreased, the cardiac output increased, the RAAS was deactivated and renal function improved. (70) (s.pp 259,314,329)... 

When diuretics are administered at the same time, it is not absolutely necessary to adhere to strict salt restriction. We followed the recommended 6-8 g/day. Indeed, such a moderate restriction is usually observed more reliably by the patient. Reducing water intake to 1.5-2.0 1/day is also sufficient. Only a hyponatraemic condition of <130 mmol/1 requires a reduction in fluid intake to <1,000 ml/day. Determination of fractional sodium elimination (FEnJ may point to potential success even before treatment has begun with a value of >0.5%, treatment steps 1 and 2 (see above) will achieve a probable success rate of about 95%. This favourable initial situation is supported by a still sufficient spontaneous sodium excretion of >40 mmol/day. Therapy resistance must be anticipated when fractional sodium elimination is <0.1% and sodium excretion is <10 mmol/day. If treatment steps 1—4 are unsuccessful or renal function is clearly impaired initially and FENa is <0.1%, the insertion of a peritovenous shunt (PVS) should be considered. This procedure is designed to make use of the principle of ascites reinfusion for as long as possible, (s. tabs. 16.14—16.18) (s. p. 311) TIPS may also prove to be an alternative to PVS, especially when using a polytetrafluoroethylene-covered stent to prevent occlusion. (Ill) (s. fig. 16.15) (s. pp 259, 314, 362)... 

A 64-year-old obese man with a history of radiocontrast-induced nephropathy had an MRI scan, which confirmed the presence of an aortic aneurysm from just below the renal arteries to the aortic bifurcation (31). Percutaneous stenting of the aortic aneurysm... 

Pergolide 3 mg/day has been associated with retroperitoneal fibrosis in an 83-year-old woman after 18 months (8). She required ureteric stents, which were removed 2 years later, after her renal function had remained stable. Because of deterioration in her Parkinson s disease the non-ergot dopamine receptor agonist ropinirole was started and treatment was uneventful after 12 months. 

Feres F +, Catheter Cardiovasc Interv 68(1), 83 (stent) Renal... 

Scobie JE. Do protection devices have a role in renal angioplasty and stent placement Nephrol Dial Transplant 2003 18 1700-3... 

Treatment consists in stopping sulfadiazine or decreasing its dosage. The acute renal failure, however, may resolve despite continuation of the treatment [39]. Hydration and especially alkalinization are the basis for the treatment. Urinary tract obstruction may require placement of ureteral stents [13], or nephrostomy [32]. This complication is essentially reversible and dialysis is rarely needed [27]. 

Treatment of psoriasis with new biologies costs in the range of 25,000- 45,000 per year as compared with 2200 for methotrexate and 3000- 5000 per year for phototherapy. The cost of erythropoietin for renal dialysis is 10,000 per year and for cancer patients 1000 per month of treatment. New vaccines are priced in the 200- 400 range. Xigris is priced at 6800 per injection and drug-coated stents at over 3000. The European government-funded healthcare systems and insurance companies try to delay and limit access to costly new medicines and try to negotiate lower prices. 

J.C. Palmaz, D.T. Kopp, H. Hayashi, R.A. Schatz, G. Hunter, F.O. Tio, O. Garcia, R. Alvarado, C. Rees, S.C. Thomas, Normal and stenotic renal-arteries—experimental balloon-expandable intraluminal stenting. Radiology 164 (1987) 705-708. 

For the Phase 1 study, sii le doses of Serp-1 protein were infused in normal volunteers as mandated by the FDA. This was the first trial in man with a new class of virus-derived native protein therapeutic No changes in cardiac, renal or hepatic function, as well as no chaises in clotting parameters were detected in this study. This Phase 1 safety study demonstrated that Serp-1 infusion was safe with no adverse events detected or reported. A Phase Ila study is currently ongoii in which the effects of a Serp-1 infusion is given for three days startup immediately after balloon ai oplasty and stent implant in patients with acute unstable angina and non-ST elevation myocardial infarction (NSTEMl). This trial is still ongoing at 7 sites in Canada and the US. The... 

The Cook Zenith AAA endovascular graft was approved for use by the FDA in May 2003 (FDA 2013). It contains three different components the main graft module, the contralateral limb module, and the ipsilateral iliac extension (Fig. 21.12). All of these are constructed with a full-thickness woven polyester fabric attached to self-expanding stainless steel Cook-Z stents with braided polyester and monofilament polypropylene sutures. The distal end of the main body has a bare stainless steel stent designed to allow suprarenal fixation without disrupting blood flow through the renal arteries (Fig. 21.13). The stent also has hooks on each strut spaced 3 mm apart that are intended to dig into the aortic wall and prevent migration (Fig. 21.13). The proximal covered stent, located just below the bare suprarenal stent. 

Currently there is only one prefenestrated endovascular stent-graft system approved by the FDA for use in the United States. It is an iteration of the Cook Zenith called the Cook Zenith Fenestrated . It is custom-made for each patient based on their personal aortic anatomy. This requires detailed CT scans of the abdominal aorta to properly locate the renal arteries and the superior mesenteric artery. The device is then manufactured with holes in the top piece for the renal arteries and a scallop at the top for the superior mesenteric artery (Fig. 21.19). These fenestrations are usually supported by a nitinol metal ring sewn around the circumference of the fenestration, as seen in the image taken from the study by Halak et al. (2006) (Fig. 21.20). 

Cook Zenith fenestrated stent-graft installed with the two fenestrations to the renal arteries and one scallop for the superior mesenteric artery. 

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