Effectiveness of mechanical thrombectomy of occluded hemodialysis access shunts with the described hydrodynamic device is similar to that of alternative treatments such as thrombolysis.

Percutaneous transluminal renal angioplasty (PTRA) was performed in 12 children and adolescents with renal artery stenosis. Patients were divided into three groups: those with a short stenosis in the middle or distal part of the renal artery (n = 5), those with a short stenosis at or near the origin of the renal artery (n = 3), and those with a long stenosis at or near the origin (n = 4). The patients in the first group responded to PTRA. Those in the second group had a poor clinical response, and dilation was unsuccessful in the patients in the third group, who remained hypertensive. The location and length of the renal artery stenosis and its underlying cause appear to be important in determining the results of PTRA.

As an alternative to MRA, full retrograde DSA is safe and effective for stenosis detection and stenosis treatment. However, access evaluation by a non-invasive imaging modality such as colour duplex ultrasound will be sufficient in most cases as proximal inflow stenoses are encountered in a minority of patients. Full retrograde DSA, including complete arterial inflow depiction, may then be reserved for cases with an unsuccessful outcome following endovascular intervention of stenoses depicted at ultrasound.

No abstract

Three patients are described with severe systemic atherosclerosis, including aortic occlusion, in the presence of a spectrum of risk factors, including hypercholesterolaemia, hypertension, a positive family history of cardiovascular problems, and hyperhomocysteinaemia. In all three patients high levels of anticardiolipin antibodies were found. The possible pathogenic role of antiphospholipid antibodies in atherosclerosis in the context of hyperhomocysteinaemia in these patients is discussed. (Ann Rheum Dis 2001;60:699-701) We describe three patients with severe systemic atherosclerosis including one with aortic occlusion. High levels of antiphospholipid antibodies (aPLs) and hyperhomocysteinaemia were present in all three patients, who were also heavy smokers. To our knowledge, this is the first report in which the relation between severe atherosclerosis, aPLs, and hyperhomocysteinaemia is discussed. There has been much debate about the possible pathophysiological role of aPLs in atherosclerosis. The presence of these autoantibodies and other known atherogenic factors in our patients is discussed. Case reportsPATIENT 1 A 41 year old man was seen at our outclinic because of hypertension. He smoked 10 cigarettes a day with a history of 25 pack years. His father also had had hypertension and angina pectoris. Apart from the hypertension (blood pressure 220/110 mm Hg), a physical examination was unremarkable. In particular, no bruits were heard over the renal arteries. The patient was taking amlodipine 5 mg/day and atenolol 100 mg/day. Ultrasound examination of his abdomen showed a smaller left kidney (12.7 cm right side; 9.2 cm left side), which had shrunk since a similar investigation one year previously (12.3 cm). As renal artery stenosis was suspected, angiography was performed.Injection of contrast into the descending thoracic aorta showed that the aorta was occluded. Huge intercostal arteries feeding collaterals over the abdominal wall to the pelvic and leg arteries were found. Severe atheromatous plaques, an occluded left renal artery, a partially (70%) occluded right renal artery, an occluded coeliac trunk, and partially (50%) occluded superior mesenteric artery were found (fig 1).In view of these findings, additional laboratory tests were carried out (table 1). Homocysteine levels were very high, and folate levels were slightly decreased. After folate treatment (5 mg once a day), homocysteine levels normalised (although still in the higher range) as measured by the methionine loading test. Anticardiolipin antibodies of both IgM and IgG class were present at high levels (repeated testing), whereas lupus anticoagulant and Venereal Disease Research Laboratory results were negative. High density lipoprotein (HDL) cholesterol concentration was decreased and triglycerides were increased. Treatment with coumarins was started.The risk of complications during or after extensive vascular surgery were explained to the patient. He declined the oVer of surgical intervention. So far (one year later), he is doin...