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Computer‐Assisted Anatomical Dissection (CAAD) of the Renal Plexus to Refine Renal Denervation in the Treatment of Refractory Hypertension
Author(s) -
Bessede Thomas,
Lebacle Cedric,
Timoh Krystel Nyangoh,
Martinovic Jelena,
Diallo Djibril,
Zaitouna Mazen,
Benoit Gerard
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.1045.1
Subject(s) - medicine , renal artery , renal hilum , anatomy , denervation , kidney , hilum (anatomy) , nerve plexus , plexus , nephrectomy
Context RadioFrequency (RF) renal denervation is an emerging treatment of refractory arterial hypertension with various possible approaches: endovascular, endourologic, laparoscopic. Results and adverse events remain controversial. Theoretical safety and efficiency of all of the approaches deserve to be addressed with special insight into the anatomy of the renal plexus and hilar structures. The objective was to describe the location and distances between nerve fibers and renal vasculature. Methods Sagittal serial sections were performed in 4 human fetuses and 10 adult bodies were dissected. In fetuses, sections were stained by Masson's trichrome, HE, and immunostained by PS100 neuronal antibody. The nature of renal plexus fibers was investigated by adrenergic (TH) and somatic (PMP22) labelings. In cadavers, the distances between nerve fibers and arteries were measured at the renal ostium, at mid‐artery, at the hilum of the kidney, and were statistically compared (one‐way repeated measures ANOVA). 3D reconstructions were performed from the digitized serial sections obtained in fetuses. Results The renal plexus can be described as a guying contained in an hourglass shape centered on the renal artery. The isthmus of this hourglass corresponds to the hilum of the kidney and is a mandatory waypoint of afferent and efferent renal plexus. At this level, the nerves are at the closest location of arterial branches (11 mm at the renal ostium, 6.5 mm at mid‐artery and 2 mm at the hilum of the kidney; p<0.001). The sectorial distribution of the nerves around the renal artery is heterogeneous and fibers predominate on the superior aspect. Nerve fibers are autonomic (PMP22−) and adrenergic‐sympathetic (TH+). With an animated 3D reconstruction, it is possible to analyze the relationship between renal plexus, vasculature and urinary tract, and the potential risks of various denervation techniques. Conclusion CAAD in fetuses identified the renal hilum as the theoretical preferential site for renal denervation. To optimize endovascular denervation in future clinical studies, a compromise should be sought between the size of the RF probe and the arteries’ diameter. There is an opening to laparoscopic surgical denervation. Support or Funding Information None