Percutaneous transluminal dilatation: A new treatment of renovascular hypertension?

Kuhlmann, Ulrich; Grüntzig, A; Vetter, W; Um, Lütolf; Meier, Bernhard; Siegenthaler, W

doi:10.1007/bf02429105

Cited by 17 publications

(4 citation statements)

References 6 publications

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“…In 1978, Andreas Gruntzig extended the practice of peripheral vascular dilation to the kidney in a seminal paper on renal artery balloon angioplasty [32;33], followed a year later by a description of initial experience with renal artery angioplasty in the United States [34]. Subsequent reports confirmed the potential for renal artery angioplasty to improve management of uncontrolled hypertension [35;36].…”

Section: Present: Endovascular Restoration Of Renal Blood Flowmentioning

confidence: 99%

Percutaneous revascularization for ischemic nephropathy: the past, present, and future

Textor

Misra

Oderich

2013

Kidney International

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Occlusion of the renal arteries can threaten the viability of the kidney when severe, in addition to accelerating hypertension and circulatory congestion. Renal artery stenting procedures have evolved from a treatment mainly for renovascular hypertension to a maneuver capable of recovering threatened renal function in patients with “ischemic nephropathy” and improving management of congestive heart failure. Improved catheter design and techniques have reduced, but not eliminated hazards associated with renovascular stenting. Expanded use of endovascular stent grafts to treat abdominal aortic aneurysms has introduced a new indication for renal artery stenting to protect the renal circulation when grafts cross the origins of the renal arteries. Although controversial, prospective randomized trials to evaluate the added benefit of revascularization to current medical therapy for atherosclerotic renal artery stenosis until now have failed to identify major benefits regarding either renal function or blood pressure control. These studies have been limited by selection bias and have been harshly criticized. While studies of tissue oxygenation using blood oxygen level dependent (BOLD) MR establish that kidneys can adapt to reduced blood flow to some degree, more severe occlusive disease leads to cortical hypoxia associated with microvascular rarefication, inflammatory injury and fibrosis. Current research is directed toward identifying pathways of irreversible kidney injury due to vascular occlusion and to increase the potential for renal repair after restoring renal artery patency. The role of nephrologists likely will focus upon recognizing the limits of renal adaptation to vascular disease and identifying kidneys truly at risk for ischemic injury at a time point when renal revascularization can still be of benefit to recovering kidney function.

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Section: Present: Endovascular Restoration Of Renal Blood Flowmentioning

confidence: 99%

Percutaneous revascularization for ischemic nephropathy: the past, present, and future

Textor

Misra

Oderich

2013

Kidney International

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“…With the introduction of percutaneous transluminal balloon angioplasty, older patients with a high operative risk may be cured of renovascular hypertension (Kuhlmann et al, 1978;Ingrisch et al, 1980a). There is thus an obvious and increasing need for a practical screening test for renal artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

Visualization of the Renal Arteries during Excretory Urography

1980

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1. Intravenous excretory urography was modified and expanded in order to visualize the aorta and the renal arteries. 2. The new procedure consists of the rapid intravenous injection of contrast medium, determination of the circulation time between the injection site and abdominal aorta, tomography with a multileaf cassette with five films (angiotomography) and continuation of the investigation as with routine excretory urography. 3. In 343 patients a total of 739 single or multiple renal arteries were identified at least partially. Of these, 83% could be clearly outlined between the aorta and the first division. 4. In 71 hypertensive patients angiography and angiotomography were separately evaluated. With angiotomography all 165 single or multiple renal arteries seen with angiography were visualized at least partially, whereas a total of 149 (90%) of renal arteries could be completely outlined between the aorta and the first division of the renal arteries. 5. A sensitivity for the presence of renal artery stenosis of 92% and a specificity for the absence of artery stenosis of 99% can be calculated for angiotomography in the diagnosis of renal artery stenosis. 6. Thus this method permits the detection or exclusion of renal artery stenosis in almost three-quarters of patients with hypertension, without angiography.

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“…From 1970 to 1978 all patients with severe stenosis of the main renal artery had surgery. After the development of PTA in our department [11], PTA was used as the treatment of choice in the same group of patients. Therefore, although the study has not been performed in a randomized manner, the 2 groups of patients were comparable in most clinical and laboratory data.…”

Section: Discussionmentioning

confidence: 99%

Fibromuscular Hyperplasia: Extension of the Disease and Therapeutic Outcome

Lüscher¹,

Keller

Imhof

et al. 1986

Nephron

101

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92 patients with fibromuscular hyperplasia (FMH) seen at the University Hospital Zurich were studied. Renovascular FMH was the most frequent manifestation of the disease (89%). FMH of the cerebral arteries was seen in 26%. The intestinal and subclavian arteries were involved in 9% each and the iliac arteries in 5% of the patients. In 2 patients each FMH of the abdominal aorta or the coronary arteries, respectively, was found. 26% of the patients had systemic disease with involvement of 2 or more arteries. Half of the patients with bilateral renovascular disease showed additional extrarenal FMH. All patients with renovascular FMH were hypertensive (mean blood pressure 194 ± 34/119 ± 18 mm Hg). Surgery, percutaneous transluminal angioplasty (PTA) and medical therapy were equally effective in controlling blood pressure. The cure rates were 52% in patients undergoing surgery and 50% in those treated with PTA. The complication rate, however, was higher with surgery (11%) than with PTA (3%). 62% of the patients treated medically were normotensive. Major side effects occurred in 4.8%. The outcome of curative interventions (surgery or PTA) was influenced by the extension of FMH. In unilateral disease the cure rate was significantly higher (62%) than in systemic FMH (28%; p < 0.03). Patients with strict bilateral disease were cured in 50%. We conclude: (a) PTA seems to be the treatment of choice in renovascular FMH because of a high cure and a low complication rate and (b) the outcome of curative interventions seems markedly influenced by the extension of FMH in these patients.

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Percutaneous transluminal dilatation: A new treatment of renovascular hypertension?

Cited by 17 publications

References 6 publications

Percutaneous revascularization for ischemic nephropathy: the past, present, and future

Percutaneous revascularization for ischemic nephropathy: the past, present, and future

Visualization of the Renal Arteries during Excretory Urography

Fibromuscular Hyperplasia: Extension of the Disease and Therapeutic Outcome

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