RENAL ANGIOGRAPHY

From Big Medical Encyclopedia

RENAL ANGIOGRAPHY (grech, angeion a vessel + grapho to write, represent; synonym renovazografiya) — a X-ray analysis of a kidney and its blood vessels after introduction to them of a contrast agent. Item and. apply to assessment of a condition of kidneys and their arterial and venous vessels when usual methods rentgenol, researches do not allow to establish character and localization patol, process or when there are not clear opportunities and volume of an operative measure.

The first rentgenol, the research of vessels of macrodrug patholologically of the changed kidney was conducted in 1913 by E. Hauch. In 1923 g Berberikh and Girsh (J. Veg-berich, S. Hirsch) the first successful intravital P.'s results published and. However only in 1929 after development by R. Dos Santos, Lamas and Kaldas (A. S. Lamas, J. River of Caldas) method of translumbar aortografiya (see) a research of kidneys by means of an angiography gained distribution to a wedge, practice. P. is especially wide and. it began to be applied since 1953 when S. Seldinger offered a method of transdermal puncture catheterization of an aorta through a femoral artery (see. Seldingera method ). First successful P. and. in the USSR it was executed in 1956 by N. A. Lopatkin.

Item and. gained the leading value in recognition and differential diagnosis various a disease of kidneys and pararenal cellulose (a pararenal adipose body, T.; corpus adiposum pararenale): malignant and benign tumors, cysts, hydronephrosis, hron, inflammatory diseases, malformations, injuries and defeats of renal vessels of various etiology.

Item and. it is contraindicated at hypersensitivity of the patient to iodinated contrast agents. P.'s carrying out is not justified and. at serious condition of the patient and at generalization patol, process. It is not recommended to carry out P. and. at the expressed atherosclerosis.

Two main ways of contrasting of a circulatory bed of a kidney are developed: the semi-selection P. and. and the selection P. and. Catheterization of vessels in both cases is carried out by Seldinger's method (by a transdermal puncture of a femoral artery the catheter is carried out to a belly part of an aorta or to a renal artery). The choice of a way of administration of contrast medium in a circulatory bed of a kidney is defined by a specific objective of a research and the nature of blood supply of a kidney.

Fig. 1. The semi-selection renal angiograms at an adenocarcinoma of a left kidney: a — an arterial phase, the semi-selection filling with a contrast agent main (1) and the left additional (2) renal arteries, is noted characteristic drawing apart vessels of a left kidney; — the parenchymatous phase, is contrasted a tumor of a left kidney (it is specified by shooters) and not struck renal parenchyma.
Fig. 2. The semi-selection renal angiograms at chronic right-hand perinephric abscess (fragment): and — an arterial phase: the semi-selection filling with a contrast agent main (1) and additional (2) arteries of a right kidney; an avascular zone in verkhnenaruzhny department of a kidney (3); — a parenchymatous phase: shift of cortical substance of a kidney inside abscess; vessels of the capsule of abscess are visible (it is specified by an arrow).

At the semi-selection P. and., or a floor-by-floor aortografiya, at the level of an otkhozhdeniye of renal arteries enter 30 — 40 ml of 76% of solution of a contrast agent into an aorta with a speed of 20 — 25 ml/sec. through a catheter with 4 — 6 side openings and the obturirovanny end or through a catheter with a loop on the end. In these conditions rather isolated simultaneous contrasting of the main and additional renal arteries on both sides is reached (fig. 1, 2). At this way P. and. not always it is possible to gain complete idea of the nature of intraorganic vascular disorders and it is impossible to carry out rentgenol, a research in two projections because of imposing of images of both kidneys at each other.

Fig. 3. The selection angiogram at adenoma of a left kidney (a direct projection): a late arterial phase with well contrasted vascular system of a kidney; in srednenaruzhny department of a kidney the vascular drawing is grown poor due to expanding and a prelum of arteries by roundish avascular education (it is specified by an arrow).
Fig. 4. The selection renal angiograms at a polycystosis of a left kidney (a direct projection): and — an arterial phase: all arterial bed of a kidney, including the deformed, moved apart vessels is well contrasted; — a parenchymatous phase: against the background of well contrasted parenchyma of a kidney multiple roundish low-contrast zones — cysts come to light (are specified by shooters).

The selection P. and. (the selection arteriography of kidneys) it is based on selective catheterization of a renal artery with the subsequent introduction to it of 10 — 15 ml of 60 — 76% of solution of a contrast agent with a speed of 5 — 8 ml/sec. For the selection P. and. use thin catheters with a standard coronoid bend of a top with trailer and side openings. The selection P.'s advantage and. an opportunity at a small amount of a contrast agent to receive the image of a kidney isolated with many details of a structure of vessels in two projections (fig. 3, 4) is. The lack of a method consists in impossibility of obtaining the simultaneous image of a circulatory bed of both kidneys. Besides, the method does not allow to define patol, the process which is localized in pararenal cellulose and communication patol, process in a kidney with adjacent bodies and the main vessels. Often found options of development of a renal artery also limit use of this method.

Apply a method of the selection renal pharmakoangiografiya to differential diagnosis of benign and malignant tumors of a kidney, in the course the cut into a renal artery through a catheter is previously entered by 0,1 ml of 0,001% of solution of adrenaline that causes a short-term spasm only of not struck vessels of a kidney. At the subsequent introduction (in 10 — 20 sec.) contrast agent vessels of a tumor against the background of spazmprovanny normal vessels are better contrasted.

Irrespective of a way of administration of contrast medium at P. and. apply water-soluble, three - the iodated contrast agents: triombrin (Urografinum, in an isotrust, Urotrastum), etc. The total amount of contrast medium depends on the weight (weight) of a body of the patient. One day before P.'s carrying out and. define sensitivity of the patient to a contrast agent. Just before a research carry out premedication, then in position of the patient on spin carry out a survey X-ray analysis of lumbar area that allows to specify exposure and to check correctness of position of the patient. Catheterization of vessels and a marking of the explored area are made under control of X-ray television (see. Television in medicine ). Having convinced of the correct provision of a catheter, carry out contrasting of vessels and a serial X-ray analysis.

The main requirement at P. and. — obtaining the separate and sharp x-ray image of kidneys in all three phases of an angiography. In an arterial phase receive the image of renal arteries, in the following, parenchymatous (capillary) phase a contrast agent fills the interlobular arteries which are bringing and taking out glomerular arterioles, capillaries and venules of a kidney that provides the intensive contrast image of its parenchyma. In the last venous phase a contrast agent comes to a venous bed, and on the roentgenogram there is an image of veins of a kidney. In need of receiving more sharp image of venous system of kidneys resort to catheterization of a renal vein (see. Kavografiya ). To receive the x-ray image of all phases P. and. use of the se-riograf and X-ray apparatus providing the speed of shooting to 3 pictures in 1 sec. at endurance about the 100-th fractions of a second allows. Speed of shooting at P. and. in the first 2 sec. makes 2 — 3 pictures in 1 sec., in the subsequent 6 — 7 sec. — not less than 1 picture in 1 sec. Duration of shooting of all phases P. and. 8 — 9 sec. make.

Complications at P. and. hl are caused. obr. errors during the carrying out catheterization of vessels (a local hematoma, a long spasm of peripheral arteries, fibrinferments of the main vessels), cases of toxic influence of a contrast agent extremely seldom meet.

See also Kidneys, methods of a research .



Bibliography: Akkerman G. L. and Romankin V. P. Aneurisms of renal arteries, Vestn, rentgenol, and radio-gramophones., No. 4, page 45, 1976, bibliogr.; Kuchinsky G. A., Matveev B. P. and Dolgushin B. I. Diagnostic opportunities of arteriography at metastatic damages of a kidney, in the same place, No. 2, page 66, 1977, bibliogr.; P and N and to r and - t about in K. D., etc. An angiographic research at a hydronephrosis, in the same place, No. 4, page 35,1976; Perelman V. M., Tailor of JT. M and Rozenshtra-u x JT. C. The current state of radiodiagnosis in urology, in the same place, page 8; The Guide to an angiography, under the editorship of. And. X. Rabkyana, page 223, M., 1977; Abrams H. L. Renal tumor versus renal cyst, Cardiovasc. Radiol., v. 1, p. 59, 125, 1978; Ekelund L. Jons son K. How is renal carcinoma detected? Int. Urol. Nephrol., v. 9, p. 3, 1977; Handbuch der medizinische Radiologie, hrsg. v. L. Diethelm, Bd 13, T. 1, B., 1973; Lehrbuch der Rontgendiagnostik, hrsg. v. H. R. Schinz u. a., Bd 5, S. 523, Stuttgart, 1965; O 1 s s o n O. Multiple expanding renal lesions, Acta radiol. (Stockh.), v. 17, p. 481, 1976; Radiology and the kidney, some present concepts, ed. by C. J. Hodson, v. 5, Basel — N. Y., 1977; Seldinger S. I. Catheter replacement of the needle in percutaneous arteriography, Acta radiol. (Stockh.), v. 5, p. 368, 1953.


G. A. Kuchinsky.

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