RT Journal Article
T1 Microdissection of the Human Renal Nervous System. Implications for Performing Renal Denervation Procedures
A1 García Touchard, Arturo
A1 Maranillo Alcaide, Eva
A1 Mompeo, Blanca
A1 Sañudo Tejero, José Ramón
AB Despite the use of renal denervation to treat hypertension, the anatomy of the renal nervous system remains poorly understood. We performed a detailed quantitative analysis of the human renal nervous system anatomy with the goal of optimizing renal denervation procedural safety and efficacy. Sixty kidneys from 30 human cadavers were systematically microdissected to quantify anatomic variations in renal nerve patterns. Contrary to current clinical perception, not all renal innervation followed the main renal artery. A significant portion of the renal nerves (late arriving nerves) frequently reached the kidney (73% of the right kidney and 53% of the left kidney) bypassing the main renal artery. The ratio of the main renal artery length/aorta-renal hilar distance proved to be a useful variable to identify the presence/absence of these late arriving nerves (odds ratio, 0.001 (95% CI, 0.00002–0.0692; P: 0.001) with a cutoff of 0.75 (sensitivity: 0.68, specificity: 0.83, area under ROC curve at threshold: 0.76). When present, polar arteries were also highly associated with the presence of late arriving nerve. Finally, the perivascular space around the proximal main renal artery was frequently occupied by fused ganglia from the solar plexus (right kidney: 53%, left kidney: 83%) and/or by the lumbar sympathetic chain (right kidney: 63%, left kidney: 60%). Both carried innervation to the kidneys but importantly also to other abdominal and pelvic organs, which can be accidentally denervated if the proximal renal artery is targeted for ablation.These novel anatomic insights may help guide future procedural treatment recommendations to increase the likelihood of safely reaching and destroying targeted nerves during renal denervation procedures.
PB American Heart Association /  Lippincott, Williams & Wilkins
SN 0194-911X
YR 2020
FD 2020-03-20
LK https://hdl.handle.net/20.500.14352/91769
UL https://hdl.handle.net/20.500.14352/91769
LA eng
NO García-Touchard A, Maranillo E, Mompeo B, Sañudo JR. Microdissection of the Human Renal Nervous System: Implications for Performing Renal Denervation Procedures. Hypertension. 2020 Oct;76(4):1240-1246. doi: 10.1161/HYPERTENSIONAHA.120.15106. Epub 2020 Aug 24. PMID: 32829660.
NO El artículo ha sido comentado muy positivamente en "Persu A, Maes F, Renkin J, Pathak A. Renal Denervation in Hypertensive Patients: Back to Anatomy? Hypertension. 2020 Oct;76(4):1084-1086. doi: 10.1161/HYPERTENSIONAHA.120.15834. Epub 2020 Sep 9. PMID: 32903105; PMCID: PMC7480938."
NO Medtronic
DS Docta Complutense
RD 20 jul 2024