Renal Artery Angioplasty: Technical Results and Clinical Outcome in 320 Patients

Bonelli, Frank S.; McKusick, Michael A.; Textor, Stephen C.; Kos, Paul B.; Stanson, Anthony W.; Johnson, Christopher M.; Sheedy, Patrick F.; Welch, Timothy J.; Schirger, Alexander

doi:10.4065/70.11.1041

Cited by 184 publications

(108 citation statements)

References 26 publications

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“…The technical success rates for percutaneous angioplasty have been reported to be greater than 90%, 2,9) with hypertension being cured (14 to 52%) or improved (21 to 74%). [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.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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“…The Mayo experience in 320 patients examined the clinical outcomes where patients with ASO 70% benefited, but only 8% were cured. In patients with FMD, 63% improved but only 22% were cured 14 . In our study, from 81 patients with low RI, the majority improved (57 patients) and 2 were cured.…”

Section: Discussionmentioning

confidence: 99%

Índice de resistividade renal como preditor da revascularização renal para hipertensão renovascular

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et al. 2010

Arq. Bras. Cardiol.

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“…13) Hypertension is more likely to be cured after revascularization in patients with FMD than in those with atherosclerotic renal artery stenosis, 13) and revascularization is also feasible in patients with a solitary kidney with 91.7% of patients benefiting from PTRA after a mean follow-up of 32.5 months. 14) Furthermore, for patients with both atherosclerosis and FMD, those with outcomes classified as treatment failures were older and had undergone treatment for hypertension for a longer period than those classified as cured. 14) Our patient was cured of hypertension immediately after PTRA, and this may have been because the renal artery stenosis was due to FMD or because of her younger age and comparatively early diagnosis and intervention.…”

Section: Discussionmentioning

confidence: 99%

“…14) Furthermore, for patients with both atherosclerosis and FMD, those with outcomes classified as treatment failures were older and had undergone treatment for hypertension for a longer period than those classified as cured. 14) Our patient was cured of hypertension immediately after PTRA, and this may have been because the renal artery stenosis was due to FMD or because of her younger age and comparatively early diagnosis and intervention. Nevertheless, long-term follow-up is essential in this case.…”

Section: Discussionmentioning

confidence: 99%

Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

et al. 2005

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SUMMARYA 24 year-old woman had a congenital solitary kidney with renovascular hypertension due to fibromuscular dysplasia. She had been treated as having essential hypertension until she developed preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 28 weeks of gestation. Plasma renin activity and captopril test results did not indicate any abnormalities. However, renography revealed captoprilinduced deterioration. Magnetic resonance angiography was also useful to detect renal artery stenosis. These findings were confirmed by renal angiography. After successful percutaneous transluminal renal angioplasty, her blood pressure and the pattern of captopril renography normalized. (Int Heart J 2005; 46: 347-353) Key words: Captopril renography, Fibromuscular dysplasia, HELLP syndrome, Magnetic resonance angiography, Renovascular hypertension, Solitary kidney RENAL artery stenosis in a patient with a solitary kidney is relatively rare. As these patients are at a high risk of developing renal insufficiency, 1) accurate assessment of the renal blood supply is essential. While angiography provides the best imaging of renal arteries and remains the gold standard, it cannot evaluate renal function and is not completely risk-free. Captopril renography, which can be used to assess the response of each of the renal functions to the renin-angiotensin system, detects renovascular hypertension (RVHT) with high sensitivity and specificity. [2][3][4] This test is also considered useful for patients with a solitary kidney, although the extent to which hypertension and renal function depend on renin is still controversial. 5) We report here a patient with a congenital solitaryFrom the

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Renal Artery Angioplasty: Technical Results and Clinical Outcome in 320 Patients

Cited by 184 publications

References 26 publications

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

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

Índice de resistividade renal como preditor da revascularização renal para hipertensão renovascular

Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

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