KATHERINE I. FIGUEROA

Albert Einstein College of Medicine

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Alla M. Rozenblit

Montefiore Medical Center

Ayal M. Kaynan

Morristown Medical Center

Seth E. Lerner

Baylor Scott & White Health

Vivian Tellis

Montefiore Medical Center

Anita L. Principe

Albert Einstein College of Medicine

Jacob Cynamon

Albert Einstein College of Medicine

Dianne Feuerstein

Montefiore Medical Center

Gattu Lal Karwa

Albert Einstein College of Medicine

S. Hoffman

Drexel University

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Montefiore Medical Center

Albert Einstein College of Medicine

Yeshiva University

Stanford University

University of Michigan–Ann Arbor

The Bronx Defenders

Cornell University

New York Medical College

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Mount Sinai Medical Center

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USE OF SPIRAL COMPUTERIZED TOMOGRAPHY IN LIEU OF ANGIOGRAPHY FOR PREOPERATIVE ASSESSMENT OF LIVING RENAL DONORS

The Journal of Urology (1999)

Ayal M. Kaynan Alla M. Rozenblit KATHERINE I. FIGUEROA S. Hoffman Jacob Cynamon

No AccessJournal of UrologyClinical Urology: Original Articles1 Jun 1999USE OF SPIRAL COMPUTERIZED TOMOGRAPHY IN LIEU OF ANGIOGRAPHY FOR PREOPERATIVE ASSESSMENT OF LIVING RENAL DONORS AYAL M. KAYNAN, ALLA M. ROZENBLIT, KATHERINE I. FIGUEROA, SETH D. HOFFMAN, JACOB CYNAMON, GATTU L. KARWA, VIVIAN A. TELLIS, and SETH E. LERNER AYAL M. KAYNANAYAL M. KAYNAN More articles by this author , ALLA M. ROZENBLITALLA M. ROZENBLIT More articles by this author , KATHERINE I. FIGUEROAKATHERINE I. FIGUEROA More articles by this author , SETH D. HOFFMANSETH D. HOFFMAN More articles by this author , JACOB CYNAMONJACOB CYNAMON More articles by this author , GATTU L. KARWAGATTU L. KARWA More articles by this author , VIVIAN A. TELLISVIVIAN A. TELLIS More articles by this author , and SETH E. LERNERSETH E. LERNER More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68796-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluate whether spiral computerized tomography (CT) can be used in lieu of renal angiography for preoperative assessment of living renal donors, with special attention to multiplicity of renal vasculature. Materials and Methods: A total of 47 living renal donor candidates were evaluated with spiral CT and all but 2 underwent donor nephrectomy. Patients were divided into early and late groups because there was a learning curve with spiral CT. In the early group 18 donors underwent renal angiography as well as spiral CT and 10 underwent nephrectomy after spiral CT only. In the late group 5 had dual radiographic evaluation for ambiguities in spiral CT interpretation and 12 underwent nephrectomy after spiral CT only. Spiral CT was performed and interpreted blind to angiographic results, and vice versa. Results: Spiral CT identified 50 of 52 renal arteries (96%) found at surgery overall and 23 of 25 (92%) found at surgery after spiral CT only. Two accessory arteries were missed in the 10 early group donors evaluated with spiral CT only, yielding an early negative predictive value of 80%. Renal angiography identified another accessory artery missed by spiral CT in the early group. All 3 missed vessels were identified retrospectively. No arteries found at surgery were missed in the late group (negative predictive value 100%), although there were 2 false-positive results detected by spiral CT relative to renal angiography in 1 candidate renal unit. Overall accuracy to predict early renal artery division relative to surgical findings was 93% for spiral CT and 91% for renal angiography.However, early renal artery division was clinically significant for only 1 of 11 vessels found at surgery. Spiral CT demonstrated 4 anomalous venous returns and renal angiography identified none. However, spiral CT missed 2 accessory veins and identified only 1 of 2 fibromuscular dysplasia cases. Total cost for spiral CT and renal angiography was $886 and $2,905, respectively. Conclusions: Spiral CT is a reasonably good alternative to renal angiography for living renal donor assessment but there is a profound learning curve for performance and interpretation. Renal angiography is still the gold standard with respect to the identification of arterial multiplicity and fibromuscular dysplasia, and it should be used adjunctively in cases with spiral CT ambiguity. Neither spiral CT nor renal angiography is ideal for the assessment of early renal artery division which is seldom an issue. The benefits of spiral CT over renal angiography are potentially lower morbidity, improved donor convenience and reduced cost. References 1 1995 Annual Report: U. S. Scientific Registry of Transplant Recipients and The Organ Procurement and Transplantation Network. Transplant Data: 1988–1995. U. S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Resources Development, Division of Transplantation. Tables 12, 18, 26–29 and 40, and Figure 9. Internet address http://www.unos.org/UNOS_ar_97/frame1.htm Google Scholar 2 : Living related kidney donors: a 14-year experience. Ann. Surg.1986; 203: 637. Google Scholar 3 : Living related kidney donors: complications and long-term renal function. Transplantation1978; 25: 221. Google Scholar 4 : Complications of angiography. Radiology1981; 138: 273. Google Scholar 5 : Potential renal donors: comparison of conventional imaging with helical CT. Radiology1996; 198: 419. Google Scholar 6 : Assessment of living renal donors with spiral CT. Radiology1995; 195: 457. Google Scholar 7 : Three-dimensional spiral CT angiography of the abdomen: initial clinical experience. Radiology1993; 186: 147. Google Scholar 8 : Selection criteria for the evaluation of living related renal donors. J. Urol.1990; 144: 845. Link, Google Scholar 9 : Management of urologic problems during pregnancy. Urology1994; 44: 159. Google Scholar 10 : Hydronephrosis of pregnancy. Amer. Fam. Phys.1991; 43: 2135. Google Scholar 11 : Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology1989; 172: 145. Google Scholar 12 : Transplantation of kidneys with fibromuscular dysplasia. Transplant. Proc.1990; 22: 398. Google Scholar 13 : Von Hippel-Lindau disease: inadequacy of angiography for identification of renal cancers. Radiology1991; 179: 833. Google Scholar 14 : The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology1991; 179: 307. Google Scholar 15 : Renal computed tomography with 3-dimensional angiography and simultaneous measurement of plasma contrast clearance reduce the invasiveness and cost of evaluating living renal donor candidates. Transplantation1996; 61: 219. Google Scholar 16 : The use of spiral computed tomography in the evaluation of living donors for kidney transplantation. Transplantation1995; 59: 643. Google Scholar 17 : Spiral CT angiography: an alternative to conventional angiography. Radiology1995; 195: 317. Google Scholar From the Departments of Urology, Radiology and Transplant Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySchlunt L, Harper J, Broome D, Baron P, Watkins G, Ojogho O and Baldwin D (2018) Multidetector Computerized Tomography Angiography to Predict Lumbar Venous Anatomy Before Donor NephrectomyJournal of Urology, VOL. 176, NO. 6, (2576-2581), Online publication date: 1-Dec-2006.LIN C, STEINBERG A, RAMANI A, ABREU S, DESAI M, KAOUK J, GOLDFARB D and GILL I (2018) Laparoscopic Live Donor Nephrectomy in the Presence Of Circumaortic or Retroaortic Left Renal VeinJournal of Urology, VOL. 171, NO. 1, (44-46), Online publication date: 1-Jan-2004. Volume 161 Issue 6 June 1999 Page: 1769-1775 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.Metrics Author Information AYAL M. KAYNAN More articles by this author ALLA M. ROZENBLIT More articles by this author KATHERINE I. FIGUEROA More articles by this author SETH D. HOFFMAN More articles by this author JACOB CYNAMON More articles by this author GATTU L. KARWA More articles by this author VIVIAN A. TELLIS More articles by this author SETH E. LERNER More articles by this author Expand All Advertisement PDF downloadLoading ...

Spiral computed tomography

10.1016/s0022-5347(05)68796-4

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A Comparison of Three-Dimensional Spiral Computed Tomoangiography with Renal Angiography in the Live-Donor Work-up

Journal of Transplant Coordination (1997)

KATHERINE I. FIGUEROA Dianne Feuerstein Anita L. Principe

The purpose of this study was to investigate the safety and efficacy of three-dimensional spiral computed tomoangiography (3-D spiral CTA) of the abdomen as a substitute for renal angiography in the evaluation of potential live kidney donors. Two of 10 potential live renal donors underwent 3-D spiral CTA only, whereas the remaining 8 underwent 3-D spiral CTA and renal angiography before transplantation. 3-D spiral CTA and renal angiography results were compared and correlated with intraoperative findings. In all 8 cases in which 3-D spiral CTA and renal angiography were compared, the number of arteries was correctly identified by both modalities. In this limited study, 3-D spiral CTA provided the same information as did angiography. According to these findings, 3-D spiral CTA might be used as an alternative to renal angiography, though a larger series is needed to determine whether it could replace renal angiography for all potential live-donor WOrk-ups.

Spiral computed tomography

Computed Tomography Angiography

10.1177/090591999700700407

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A comparison of three-dimensional spiral computed tomoangiography with renal angiography in the live-donor work-up

Journal of Transplant Coordination (1997)

KATHERINE I. FIGUEROA Dianne Feuerstein Anita L. Principe

Spiral computed tomography

Computed Tomography Angiography

Conventional angiography

10.7182/prtr.1.7.4.2p24p5vg11132186