Hossein Hodjati1,2, Seyed Masood Moosavi1, Ahmad Hosseinzadeh1,3, Mohammad Hossein Anbardar2, Shaghayegh Sherafatmand4, Khalil Kazemnia4, Hamidreza Hosseinpour5, Reza Shahriarirad6,7. 1. Department of Vascular Surgery, Shiraz University of Medical Science, Shiraz, Iran. 2. Department of Pathology, School of Medicine, Namazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. 3. Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 4. Department of Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 5. Department of Surgery, Shiraz Laparoscopic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 6. Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. r.shahriari1995@gmail.com. 7. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. r.shahriari1995@gmail.com.
Abstract
BACKGROUND: Renal artery stenosis is caused by a heterogeneous group of diseases, including atherosclerosis and fibromuscular dysplasia, which can be treated medically, via endovascular techniques, or by open revascularization; however, satisfactory and effective results are not always obtained. We aimed to assess the possibility of renal revascularization by a pedicled intestinal segment wrapping the kidney. METHODS: Five dogs were operated on at three steps. At the first step, laparotomy was performed, and the right kidney was released. Subsequently, an 8-10 cm segment of jejunum was separated longitudinally, and mucosectomy was done. This intestinal patch wrapped up the kidney. After eight weeks, the kidney and the intestinal patch were analyzed, and the renal artery was ligated. After four weeks, the kidney and the intestinal patch were sent for pathological evaluation. RESULTS: At the 12th week of evaluation, no evidence of abscess formation or collection was seen. All kidneys had a normal color, consistency, and size. All renal cells were alive, and neither atrophy nor necrosis was seen. Glomerulus and tubules were intact, and no inflammatory change was visible. Furthermore, thick wall vasculature was inspected in a fibromuscular tissue, rising from the intestinal flap toward the kidney. One of the dogs expired due to peritonitis and sepsis in the fifth week. CONCLUSION: In our study, indirect perfusion of the kidney by an intestinal patch was achieved successfully. This represents new hope in patients suffering from chronic renal failure who underwent former medical and surgical interventions with undesirable results.
BACKGROUND: Renal artery stenosis is caused by a heterogeneous group of diseases, including atherosclerosis and fibromuscular dysplasia, which can be treated medically, via endovascular techniques, or by open revascularization; however, satisfactory and effective results are not always obtained. We aimed to assess the possibility of renal revascularization by a pedicled intestinal segment wrapping the kidney. METHODS: Five dogs were operated on at three steps. At the first step, laparotomy was performed, and the right kidney was released. Subsequently, an 8-10 cm segment of jejunum was separated longitudinally, and mucosectomy was done. This intestinal patch wrapped up the kidney. After eight weeks, the kidney and the intestinal patch were analyzed, and the renal artery was ligated. After four weeks, the kidney and the intestinal patch were sent for pathological evaluation. RESULTS: At the 12th week of evaluation, no evidence of abscess formation or collection was seen. All kidneys had a normal color, consistency, and size. All renal cells were alive, and neither atrophy nor necrosis was seen. Glomerulus and tubules were intact, and no inflammatory change was visible. Furthermore, thick wall vasculature was inspected in a fibromuscular tissue, rising from the intestinal flap toward the kidney. One of the dogs expired due to peritonitis and sepsis in the fifth week. CONCLUSION: In our study, indirect perfusion of the kidney by an intestinal patch was achieved successfully. This represents new hope in patients suffering from chronic renal failure who underwent former medical and surgical interventions with undesirable results.