Long-term Results After Surgical Reconstruction for Renal Artery Fibromuscular Dysplasia

Reiher, L.; Pfeiffer, T.; Sandmann, W.

doi:10.1053/ejvs.2000.1201

Cited by 27 publications

(22 citation statements)

References 17 publications

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“…In contemporary surgical series, technical success rates are greater than 88%, long-term blood pressure was either cured or improved in 67% to 93%, and improvement or stabilization of renal function was seen in up to 92% of patients [60,61]. Cure rates in the more recent surgical series are lower than the rates reported in earlier series [62].…”

Section: Surgerymentioning

confidence: 88%

Fibromuscular dysplasia

Slovut¹,

Olin

2005

Curr Treat Options Cardio Med

193

100

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The most common clinical manifestations of fibromuscular dysplasia (FMD) are hypertension due to renal artery involvement and transient ischemic attack or stroke due to carotid or vertebral artery involvement. Patients with renal artery FMD and hypertension should undergo primary angioplasty with the goal of curing the hypertension. If the blood pressure fails to normalize following angioplasty, the physician should institute antihypertensive medications according to the recommendations of the Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure VII. In patients with cerebrovascular FMD, antiplatelet agents represent the cornerstone of therapy. Percutaneous angioplasty has emerged as the preferred treatment for symptomatic cerebrovascular FMD.

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Section: Surgerymentioning

confidence: 88%

Fibromuscular dysplasia

Slovut¹,

Olin

2005

Curr Treat Options Cardio Med

193

100

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“…In particular, 2 contemporary reports on the effect on hypertension noted cure, improved, and failure rates after PTA of 27%, 60%, 13% and after surgery of 36%, 31%, and 33% (with a 2% mortality), respectively. 258,260 Both studies represent poorer outcomes than either group had expected on the basis of earlier experience. It is important to note, however, that combined rates of cure or improvement with surgery do not appear to be worse than with PTA.…”

Section: Outcomes Of Surgical Revascularizationmentioning

confidence: 97%

Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions

Olin¹,

Gornik²,

Bacharach³

et al. 2014

Circulation

395

490

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“…[10][11][12] The technical success rates of surgical reconstruction are over 88%, with hypertension being cured (33 to 36%) or improved (31 to 57%). 3,4,13) Currently, revascularization is indicated in certain types of patients: those with hypertension of recent onset; patients whose blood pressure cannot be lowered to the desired goal despite a reasonable medication regimen; patients who are unable to tolerate antihypertensive medications or do not comply with their medication regimen; and patients with loss of parenchymal mass from ischemic nephropathy. In the present case, blood pressure control was difficult to achieve despite the use of a comprehensive antihypertensive regimen.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with RAS, renal revascularization by percutaneous transluminal angioplasty or surgical reconstruction is indicated to cure hypertension or to improve blood pressure control. [2][3][4] Atherosclerotic RAS, which is the most frequent type of RAS and more common in the elderly, is reported to be associated with frequent abnormalities of left ventricular (LV) function and episodes of heart failure, often mediated through labile systemic hypertension and exacerbation of myocardial ischemia. Many of those patients with atherosclerotic RAS and heart failure have been reported to benefit from renal revascularization for the control of blood pressure and also heart failure.…”

Section: F Ibromuscular Dysplasia (Fmd) Is An Idiopathic Nonath-mentioning

confidence: 99%

Efficacy of Renal Revascularization in a Patient With Fibromuscular Renal Artery Stenosis and Heart Failure

et al. 2010

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SummaryWe report the case of a 65-year-old woman with a solitary kidney who developed hypertension due to renal artery stenosis caused by fibromuscular dysplasia. In addition, an echocardiogram revealed severe left ventricular systolic and diastolic dysfunction. Despite antihypertensive drug treatment that included diuretics, her serum concentration of brain natriuretic peptide was persistently elevated and associated with progressive worsening of renal function. She underwent iliac artery to renal artery bypass grafting. After the surgery, blood pressure control was good, the serum concentration of brain natriuretic peptide decreased, and left ventricular diastolic function improved. This case exemplifies the efficacy of renal revascularization in patients with fibromuscular renal artery stenosis and heart failure. (Int Heart J 2010; 51: 432-435) Key words: Fibromuscular dysplasia, Renal artery stenosis, Heart failure, Renal revascularization F ibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic disease of the musculature of arterial walls that leads to the narrowing of the arterial lumen. 1) FMD is the most frequent cause of renal artery stenosis (RAS) after atherosclerosis. RAS often results in difficult-to-control hypertension, especially in patients with bilateral RAS or its equivalent, RAS in a solitary functioning kidney. In patients with RAS, renal revascularization by percutaneous transluminal angioplasty or surgical reconstruction is indicated to cure hypertension or to improve blood pressure control.2-4) Atherosclerotic RAS, which is the most frequent type of RAS and more common in the elderly, is reported to be associated with frequent abnormalities of left ventricular (LV) function and episodes of heart failure, often mediated through labile systemic hypertension and exacerbation of myocardial ischemia. Many of those patients with atherosclerotic RAS and heart failure have been reported to benefit from renal revascularization for the control of blood pressure and also heart failure. 5) In contrast, FMD is more common among females and most cases of FMD correspond to patients younger than 50 years. There have been few reports describing patients with RAS caused by FMD who presented congestive heart failure, and the outcome of renal revascularization in those patients was not clear. Here, we describe the case of a 65-year-old woman with a solitary kidney and hypertension due to RAS caused by FMD who also had LV dysfunction. The patient underwent surgical renal revascularization, which led to good control of blood pressure as well as an improvement of cardiac functioning. Case ReportThe patient was 65 years old at the time of admission. She had developed hypertension at the age of 17, and 8 years later she had undergone surgical reconstruction using a bypass graft of the left renal artery due to stenosis caused by FMD. However, the bypass graft became occluded after the procedure, and nephrectomy of her left kidney was performed.At age 60, she was referred to our hospital again for the...

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Long-term Results After Surgical Reconstruction for Renal Artery Fibromuscular Dysplasia

Abstract: Vascular surgery for RFMD yields good long-term results as to kidney perfusion and function. Surveillance of RAR-patency by means of ultrasound examination is mandatory in case of recurrence of arterial hypertension or deterioration. Rates of cure of hypertension are disappointing.

Cited by 27 publications

References 17 publications

Fibromuscular dysplasia

Fibromuscular dysplasia

Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions

Efficacy of Renal Revascularization in a Patient With Fibromuscular Renal Artery Stenosis and Heart Failure

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