Renovascular Hypertension and Ischemic Nephropathy: Angioplasty and Stenting

Textor, Stephen C.; McKusick, M.

doi:10.1016/b978-141605484-9.50060-5

Cited by 4 publications

(3 citation statements)

References 62 publications

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“…However, the mean age of the patients treated in the 1960s and 1970s was drastically lower as compared with current series. As reported by Textor and McKusick, the mean ages of published series concerning renal revascularization dating by to the 1970s have increased by more than 15 years [41]. This implies a longer background history of hypertension, and a greater risk of comorbidities such as diabetes, peripheral vascular disease, coronary and carotid changes, as well as intrarenal small vessels lesions.…”

Section: Differences In Response To Treatment According To Stenosis Cmentioning

confidence: 85%

Renal Artery Stenosis: A Unique Disease or a Broad Spectrum of Different Diseases?

Zuccalà¹,

Losinno²,

Lifrieri³

et al. 2007

CHYR

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Renal ischaemia due to renal artery stenosis (RAS) may be the cause of end-stage renal failure in a growing number of patients. In recent years, decisions taken on the optimal management of patients with renal artery stenosis have sparked controversy and debate among cardiologists, internists and nephrologists. The main reason underlying the ongoing controversy may be the heterogeneity of clinical entities that are normally grouped together through the use of the umbrella term renal artery stenosis. Actually, when thinking of renal artery stenosis our view is still deeply shaped by Goldblatt's seminal study. Yet it should be remembered that in Goldblatt's experiment renal artery clipping occurred in the context of a perfectly healthy vascular tree. A clinical situation that comes close to Goldblatt's experiment is the one in which the stenosis mainly, if not exclusively, affects the renal artery in relatively young subjects whose vascular tree is not badly damaged. In clinical practice, this situation is frequently encountered in subjects bearing fibromuscular dysplasia (FMD), non-ostial or truncal stenosis (Tru-RAS), and stenosis of the transplanted kidney (TRAS). Contrariwise, ostial stenosis is more precisely a lesion of the thickened aortic wall that encroaches upon the renal artery ostium, rather than a lesion in the renal artery itself. Hence, the reference paradigm ought not to be Goldblatt's model but rather more complex models in which the narrowing of the renal artery is associated to other factors, such as a high cholesterol diet, smoking or aging. The causes of renal impairment are likely to be different in the two situations. In pure renal artery stenosis (FMD, TruRAS, TRAS), the decrease in GFR is mainly caused by hypoperfusion secondary to stenosis, which is then reversible after revascularization, while in subjects with ostial stenosis and/or in older subjects with a badly injured aorta the pathogenesis is multifactorial, with intrarenal atheroma, cholesterol embolism and ischaemic damage all making a contribution. This may account for the lack of correlation between the degree of stenosis and the entity of renal impairment, as well as the low rate of renal function recovery in subjects with ostial stenosis. In our view, keeping the different entities separate enables clinicians to take the right decision on revascularization

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Section: Differences In Response To Treatment According To Stenosis Cmentioning

confidence: 85%

Renal Artery Stenosis: A Unique Disease or a Broad Spectrum of Different Diseases?

Zuccalà¹,

Losinno²,

Lifrieri³

et al. 2007

CHYR

View full text Add to dashboard Cite

show abstract

“…[18][19][20] Nevertheless the mean age of the patients treated in the 1960s and 1970s was drastically lower if compared to the current series. As reported by Textor and McKusick, 21 the mean age of published series of patients submitted to renal revascularization over the last thirty years has risen by more than 15 years.…”

Section: Introductionmentioning

confidence: 81%

“…21,22 -A badly damaged abdominal aorta is a drawback to revascularization. The clinician should evaluate the ratio between the severity of stenosis and the damage of aortic wall accurately: the best results will be obtained when stenosis is severe and the aorta wall is relatively well preserved ( Figure 2B).…”

Section: Prognostic Criteria For Treatment: Computed Tomography Angiomentioning

confidence: 99%

When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

Zuccalà¹,

Rapanà²,

Mandreoli³

2013

Ital J Med

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In recent years, decisions taken on the optimal management of patients with renal artery stenosis have triggered off controversy and debate among clinicians dealing with renovascular disease. The main reason underlying this ongoing controversy may be the heterogeneity of the clinical entities that are normally associated with the umbrella definition of renal artery stenosis. Indeed a causal link between the stenosis and its clinical consequences (i.e. hypertension, renal failure) can often demonstrated in some entities, such as fibromuscular dysplasia, truncal stenosis or arterial stenosis in the transplanted kidney, which can be defined as pure renal artery stenosis. On the contrary, the entity generally called ostial stenosis is a disease of the abdominal aorta where it encroaches the ostium of the renal artery at the end of a long process involving the entire vascular tree. Patients affected by ostial stenosis also suffer from generalized atherosclerosis, and kidney damage is often caused by the atherosclerotic environment with the stenosis acting as an innocent bystander. This may account for the low rate of renal function recovery in subjects with ostial stenosis. In our view, keeping the different entities separate along with a careful understanding of the mechanisms underpinning renal damage, particularly the intrarenal activation of the renin angiotensin system which in turn induces renal inflammation and oxidative stress, may enable clinicians to make the right decisions in regard to revascularization.

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Renal Artery Angioplasty and Stent Insertion: An Overview of Modern Practice

Gregory,

Sabharwal

2024

Mastering Endovascular Techniques

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Renovascular Hypertension and Ischemic Nephropathy: Angioplasty and Stenting

Cited by 4 publications

References 62 publications

Renal Artery Stenosis: A Unique Disease or a Broad Spectrum of Different Diseases?

Renal Artery Stenosis: A Unique Disease or a Broad Spectrum of Different Diseases?

When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

Renal Artery Angioplasty and Stent Insertion: An Overview of Modern Practice

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