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Renal artery stenosis

Rodrigo Hagemann, Vanessa Dos Santos Silva, Fábio Cardoso Carvalho, Pasqual Barretti, Luis Cuadrado Martin, Diana Vassallo, Philip A Kalra, Roberto Jorge da Silva Franco
BACKGROUND: To date, renal revascularization has not been shown to be advantageous when compared to optimized medical treatment in patients with atheromatous renovascular disease (ARVD). This study aims to investigate the effect of revascularization in patients with pre-intervention worsening renal function and in those with stable renal function. PATIENTS AND METHODS: In this single-centre observational study, patients who were diagnosed with at least 60% angiographic stenosis unilaterally or bilaterally between January 1996 and October 2008 and who were followed-up until February 2011 were retrospectively analysed...
October 21, 2016: Nephron
Gang Wu, Jun Yang, Tianjing Zhang, John N Morelli, Shivraman Giri, Xiaoming Li, Wenlin Tang
BACKGROUND: The high incidence of renal insufficiency in patients with Peripheral Arterial Disease raises the concern for nephrogenic systemic fibrosis (NSF) with respect to contrast enhanced MRA. The risk of NSF is eliminated with non-contrast enhanced magnetic resonance angiography. The purpose of the current study is to compare image quality and diagnostic performance of non-contrast enhanced Quiescent Interval Single Shot (QISS) magnetic resonance angiography at 3 T versus CT angiography for evaluation of lower extremity Peripheral Arterial Disease (PAD)...
October 20, 2016: Journal of Cardiovascular Magnetic Resonance
Donghoon Choi
: Atherosclerotic renal artery stenosis is an increasingly recognized medical problem especially in elderly patients. It commonly occurs with systemic manifestations including hypertension (HTN), chronic kidney disease (CKD) or atherosclerotic diseases including coronary or peripheral artery disease. Significant renal artery stenosis may result in HTN, ischemic nephropathy, however it is still in debate about the benefit of revascularization. Although several randomized controlled trials including Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) and Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study has failed to reveal a significant benefit of angioplasty, angioplasty with medical therapy is increasingly accepted in some patients with certain clinical conditions...
September 2016: Journal of Hypertension
George Bakris
Renal denervation started out as a very promising approach to treat resistant hypertension with a very strong conceptual and basic science frame work from Gerald DiBona's lab and extending into the early non shame clinical studies demonstrating proof of concept in SYMPLICITY HTN-1 and 2. SYMPLICITY-HTN 3 a properly done, sham control trial failed to show a benefit on further reduction of BP compared to the sham group. The conclusion the procedure doesn't work. How could this be-it was clearly effective in animal models but why not in man...
September 2016: Journal of Hypertension
Hack-Lyoung Kim, Myung-A Kim, Wan-Joo Shim, Mina Kim, Seong Mi Park, Mi Seung Shin, Gil Ja Shin, Kyung-Soon Hong, Kyoung Im Cho, Yong Hyun Kim, Hyun Ju Yoon
OBJECTIVE: Pulse pressure (PP) is usually increased in patients with coronary artery disease (CAD). This study was performed to investigate whether increased PP is predictive of angiographic obstructive CAD beyond traditional risk factors. DESIGN AND METHOD: Study data were obtained from a nation-wide registry, composed of 933 patients (age, 59.4 ± 10.8 years, 710 women) with suspected CAD who underwent invasive coronary angiography. Obstructive CAD was defined as angiographic findings of ≥ 50% diameter stenosis in any major epicardial coronary arteries...
September 2016: Journal of Hypertension
Yan Li
Blood pressure in the morning or at night are both significant cardiovascular risk predictors. Morning blood pressure either recorded with 24-h ambulatory blood pressure monitoring (ABPM) or self-measured at home predicted stroke and cardiovascular mortality in Asian populations. In 757 Chinese hypertensive patients, only morning blood pressure was independently associated with asymptomatic intracranial arterial stenosis. While in the IDACO (International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome) study, nocturnal blood pressure was superior to daytime blood pressure in predicting mortality risk, but as similarly predictive as daytime for combined fatal and nonfatal cardiovascular events...
September 2016: Journal of Hypertension
Agnes Trautmann, Derek J Roebuck, Clare A McLaren, Eileen Brennan, Stephen D Marks, Kjell Tullus
OBJECTIVES: Renovascular disease (RVD) is found in about 10 % of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children. PATIENTS AND METHODS: A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA...
October 17, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
F Toth, G Zadori, R Fedor, L Illesy, M Szabo-Pap, Z Kanyari, D A Kovacs, L Asztalos, B Nemes
INTRODUCTION: Approximately 10% of renal allografts fail during the first year after kidney transplantation (KT) and 3%-5% thereafter yearly. The indication and timing of allograft nephrectomy (AN) is still uncertain in some cases. The aim of this study was to reveal the ratio, etiology, and complications of AN at our center. MATERIAL AND METHODS: This is a retrospective study of all patients who underwent KT at our center between January 1, 2004 and December 31, 2014...
September 2016: Transplantation Proceedings
M Szabo-Pap, G Zadori, R Fedor, L Illesy, F Toth, Z Kanyari, D A Kovacs, B Nemes
Surgical complications (SCs) are still high potential causes of graft loss. The incidence has a huge amount of variations depending on many factors. Our aim was to study the postoperative technical complications following kidney transplantations (KTs) during a 5-year period between 2011 and 2015. In the observed time frame there were 47 SCs occurring in 32 (19.4%) patients of 165 KTs. Every complication was classified into 3 groups: vascular (11; 6.6%), urologic (16; 9.7%), and any others (20; 12.1%). The most common postoperative SCs in our center were hemorrhage (14; 8...
September 2016: Transplantation Proceedings
Yukihisa Ogawa, Hiroshi Nishimaki, Kiyoshi Chiba, Kenji Murakami, Yuka Sakurai, Keishi Fujiwara, Takeshi Miyairi, Yasuo Nakajima
A woman in her 80s with an infrarenal aortic aneurysm was scheduled for endovascular aortic repair (EVAR). The aneurysm had a severely angulated neck (SAN), and the Zenith Flex device was selected. Completion angiography showed migration of the main body resulting in right renal artery stenosis. A Palmaz genesis was placed across the renal orifice. The patient had no renal dysfunction and was discharged 7 days after EVAR. If Zenith Flex devices are used for a SAN, it is necessary to consider not only the position of the renal artery but also the appropriate position of the stent-graft...
2016: Annals of Vascular Diseases
Takaaki Saito, Hiroki Tanaka, Naoto Yamamoto, Kazunori Inuzuka, Masaki Sano, Naoki Unno
We report the rare case of a 54-year-old man with uncontrolled renovascular hypertension, who was found to have an abdominal aortic aneurysm with congenital solitary pelvic kidney and superior mesenteric artery stenosis. A single renal artery branched from aneurysmal aortic bifurcation, and both the renal artery and the superior mesenteric artery (SMA) had severe stenosis at their origins. The aneurysm was repaired with a bifurcated Dacron graft, to which the renal artery was anastomosed. SMA bypass was created between the graft's left limb and the SMA using another Dacron graft...
2016: Annals of Vascular Diseases
Rosario Cianci, Biagio Barbano, Antonietta Gigante, Edoardo Rosato, Alvaro Zaccaria, Nicola Mangialardi
No abstract text is available yet for this article.
September 30, 2016: International Journal of Cardiology
Satyam Veean, Nancy Thakkar, Supriya Gupta, Jayanth Keshavamurthy
No abstract text is available yet for this article.
October 5, 2016: Postgraduate Medical Journal
Kai Jiang, Christopher M Ferguson, Behzad Ebrahimi, Hui Tang, Timothy L Kline, Tyson A Burningham, Prassana K Mishra, Joseph P Grande, Slobodan I Macura, Lilach O Lerman
Purpose To test the utility of magnetization transfer imaging in detecting and monitoring the progression of renal fibrosis in mice with unilateral renal artery stenosis. Materials and Methods This prospective study was approved by the Institutional Animal Care and Use Committee. Renal artery stenosis surgery (n = 10) or sham surgery (n = 5) was performed, and the stenotic and contralateral kidneys were studied longitudinally in vivo at baseline and 2, 4, and 6 weeks after surgery. After a 16.4-T magnetic resonance imaging examination, magnetization transfer ratio was measured as an index of fibrosis (guided by parameters selected in preliminary phantom studies)...
October 3, 2016: Radiology
Mansur Duran, Daniel Ferdinand Hausmann, Klaus Grabitz, Hubert Schelzig, Florian Simon, Tolga Atilla Sagban
OBJECTIVE: Renal artery (RA) aneurysm (RAA) is a rare and complex disease. Treatment options for a RAA include endovascular surgery and open surgery with ex vivo repair or in situ reconstruction. This study evaluated the long-term outcome after vascular reconstruction of RAAs using the tailoring technique. Tailoring or aneurysmorrhaphy means a partial resection of the aneurysm with direct suture of the remaining arterial wall. METHODS: A single-center retrospective study was conducted between January 1990 and December 2015...
September 26, 2016: Journal of Vascular Surgery
Benjamin W Starnes, Rachel E Heneghan, Billi Tatum
OBJECTIVE: The objective of this study was to report midterm results of an ongoing physician-sponsored investigational device exemption pivotal clinical trial using physician-modified endovascular grafts (PMEGs) for treatment of patients with juxtarenal aortic aneurysms who are deemed unfit for open repair. METHODS: Data from a nonrandomized, prospective, consecutively enrolling investigational device exemption clinical trial were used. Data collection began on April 1, 2011, and data lock occurred on May 31, 2015, with outcomes analysis through December 31, 2015...
September 26, 2016: Journal of Vascular Surgery
Reem Daloul, Aubrey R Morrison
The management of atherosclerotic renal artery stenosis in patients with hypertension or impaired renal function remains a clinical dilemma. The current general consensus, supported by the results of the Angioplasty and Stenting for Renal Atherosclerotic Lesions and Cardiovascular Outcomes for Renal Artery Lesions trials, argues strongly against endovascular intervention in favor of optimal medical management. We discuss the limitations and implications of the contemporary clinical trials and present our approach and formulate clear recommendations to help with the management of patients with atherosclerotic narrowing of the renal artery...
October 2016: Clinical Kidney Journal
Dharshan Lakshminarayan, Tarec K Elajami, Suresh Devabhaktuni, Francine K Welty
Lipoprotein(a) [Lp(a)] is an apolipoprotein(a) molecule bound to 1 apolipoprotein B-100. Elevated levels of Lp(a) are thought to be an independent risk factor for atherosclerosis and to promote thrombosis through incompletely understood mechanisms. We report a 34-year-old man with an ischemic stroke in the setting of an extremely high Lp(a) level-212 mg/dL. He developed severe carotid artery stenosis over a 6-year period and had thrombus formation post-carotid endarterectomy. To our knowledge, this case is unique because the Lp(a) is the highest reported level in a patient without renal disease...
September 2016: Journal of Clinical Lipidology
Michael A Bolen, Ellen Brinza, Rahul D Renapurkar, Esther S H Kim, Heather L Gornik
OBJECTIVES: This study sought to evaluate the diagnostic yield of a dedicated computed tomography angiography (CTA) protocol of the chest, abdomen, and pelvis in patients with fibromuscular dysplasia (FMD). BACKGROUND: FMD is an uncommon vascular disease that may result in stenosis, dissection, or aneurysm of nearly all arterial distributions, typically affecting medium-sized arteries. Findings from the United States Registry for Fibromuscular Dysplasia have suggested the potential need to perform screening imaging of the aorta and medium branch vessels...
September 16, 2016: JACC. Cardiovascular Imaging
Fernando Korkes, Marcel Silveira, Oseas Castro Neves-Neto, Luiz Franco Brandão, Marcos Tobias-Machado, Nelson Wolosker, Felipe Nasser, Alexandre Maurano
Nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the LRV and dilatation of the distal portion. Hematuria, proteinuria, flank pain, varicocele and pelvic congestion may occur, occurring more frequently in young adults. Conservative management, might be the option whenever it is possible. When surgical treatment is required, classically open surgery have been performed, with major surgeries as LRV transposition or bypass techniques...
September 20, 2016: International Braz J Urol: Official Journal of the Brazilian Society of Urology
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