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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Multiple renal arteries originating from the aortoiliac vessels were identified angiographically in 44% of 444 prospective renal donors. Bilateral multiple renal arteries were identified in 12%. With good immunological donor-recipient matching, 17 kidneys with multiple renal arteries were transplanted with excellent results; therefore, presence of multiple renal arteries should not be considered a contraindication to kidney transplantation. A high proportion (17%) of the prospective donors, acceptable by all other means of evaluation, had abnormmal angiographic findings that led to reconsideration of their acceptance. In addition to multiple renal arteries, neither renovascular atherosclerosis nor fibromuscular dysplasia proved to be an absolute contraindication to transplantation.
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PMID:Results and significance of angiography in potential kidney donors. 38 50

A study of 44 hypertensive patients with unilateral renovascular or renal parenchymal disease is presented. All patients underwent corrective surgery. Out of the 44 operated patients, five did not participate in the follow-up examination. The remaining 39 patients constitute the study population. The effects of surgery on the hypertensive state could be evaluated in 35 patients, whereas four died less than two months after the operation. Follow-up studies were carried out at 8-60 months after the operation. The average period of observation was 32 months; 24 patients were observed for more than two years. As a group, the patients had severe hypertension with extensive target organ damage and widespread atherosclerosis. A fairly rigorous selection process was applied, and an unsatisfactory response to medical management was considered a point of major importance. In the majority of cases, renovascular lesions were atherosclerotic, with only two cases of fibromuscular dysplasia. Unilateral nephrectomy was performed in 32 patients, whereas seven underwent reconstructive vascular surgery. Out of 35 patients, 22 (63%) were cured, 8 (23%) improved and 5 (14%) unaltered. A gratifying regression of hypertensive lesions in target organs was observed in patients who were cured or improved by surgery. The frequency and severity of postoperative complications were related to the presence of extrarenal vascular disease.
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PMID:A follow-up study of hypertensive patients after operative treatment of unilateral renovascular or renal disease. 47 83

147 operations for renovascular hypertension were performed in 125 patients. 136 of the operations were vascular reconstructions. Aortorenal by-pass, using saphenous vein as a graft, was found to be a satisfactory technique. An aneurysmatic dilatation developed twice, which on both occasions was attributed to a stenosis proximal to the graft. Two failures also occurred among the 12 patients undergoing renal autotransplantation, both due to an illiac vein thrombosis, obstructing the renal vein. The majority of the six deaths were due to myocardial infarctions or uremia. They all occurred in the eldest patients (older than 59 years) and in patients suffering from complicating cardiac or renal disease. The results with regard to blood pressure were very good in fibrous dysplasia and in atherosclerosis affecting only one side. Operative treatment can therefore be recommended to these groups of patients even in relatively mild hypertension. The indication to operate should be restricted in elderly patients suffering from cardiac and renal complicating diseases, and in patients with bilateral atherosclerotic stenosis.
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PMID:Technique and complications in the surgical treatment of renovascular hypertension. 49 59

In summary, renovascular surgery has evolved during the past 20 years to become a highly efficacious therapeutic modality provided proper patient selection is practiced. Surgical techniques are now well established, and with the advent of ex vivo techniques practically any extraparenchymal renal artery lesion may be repaired. At present, much investigative work is in progress in an attempt to develop better means of selecting patients who will benefit from renovascular surgery. The newer modifications of renal vein renin assays may permit better patient selection. Many factors must be weighted when considering medical versus surgical management of hypertension. Paramount among these must be the quality of life of the patient. The inconstancy of pressure control and the frequency of undesirable side effects in the more extreme medical regimens are the primary disadvantages of nonsurgial management. An aggressive surgical approach appears to be warranted in selected patients with atherosclerosis and in almost all patients with fibromuscular dysplasia.
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PMID:Renovascular hypertension. 73 40

Thirty-two cases of fibrous-muscular dysplasial of renal arteries (including one autopsy case) were studied. Sections of renal arteries removed at reconstructive operations from patients suffering from renovascular hypertension were examined. Two morphological variants of the process were distinguished: medial dysplasia (perimedial fibroplasia, medial fibroplasia, and dissecting aneurysm) and intimal proliferation. Morphologically, fibrous-muscular dysplasia is a manifestation of proliferation of smooth muscle cell which appears to have various forms and stages. Diagnostically, fibrous-muscular dysplasia should be differentiated from atherosclerosis, nonspecific arteritis, proliferation of the intima due to hypovolemia, and perivascular sclerosis of different etiologies.
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PMID:[Fibromuscular dysplasia of the renal arteries]. 90 Dec 51

The coronary arteries were examined in 60 specimens from patients with mitral stenosis. In three, localized obstruction was nonatherosclerotic in nature (in one, arterial dysplasia; in two, embolic). In 18 of the remaining 57 cases (31.5%), significantly obstructive atherosclerosis in one or more segments of the coronary arterial system was found. This represented 46% of the males and 27% of the females. The incidence of involvement of three or more arteries by significantly obstructive atherosclerosis was 39%, while in a cited series of subjects with angina pectoris three or more vessels were involved in 79% of the cases. It may be concluded that, on the average, the distribution of lesions in patients with mitral stenosis and significant coronary atherosclerosis is less wide than in subjects with clinical coronary disease.
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PMID:Coronary atherosclerosis in subjects with mitral stenosis. 94 83

The examination was conducted in 72 patients with renovascular hypertension caused by fibromuscle dysplasia of the renal arteries. According to the authors, fibromuscle dysplasia of the renal arteries stands third after atherosclerosis and non-specific aorto-arteritis. Among the preliminary diagnostic measures of importance are such as intravenous urography, isotope renography, scintigraphy, but their value is much lower than in cases of atherosclerotic stenosis or stenosis due to non-specific aorto-arteritis, which is attributed to a good collateral circulation in the kidney. The diagnosis is made on the basis of serial angiography data. Of importance is also the method of selective renal angiography with functional tests with acetylcholoine and adrenalin. To characterize the form of renal artery pathology, three types of stenosis are distinguished: monofocal, multifocal, tubular. The terminology and classification are discussed, and a new term is suggested: "fibrous dysplasia of renal arteries".
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PMID:[Fibrous dysplasia of renal arteries (terminology, classification, clinical aspects and diagnosis)]. 102 97

Renal artery dissection is a rare complication of catheter arteriography. Predisposing factors include atherosclerosis and fibromuscular dysplasia. Optimum management requires aortographic documentation of the extent of vascular obstruction. Dissections causing incomplete obstruction of blood flow can be treated with systemic anticoagulation to prevent downstream thrombosis and should be followed with serial isotope blood flow studies and LDH measurements. Dissection causing complete vascular obstruction usually requires immediate surgery, although spontaneous reestablishment of flow may occur. The 3 patients discussed illustrate a spectrum of findings, including the acute development of renovascular hypertension.
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PMID:Renal artery dissection: a complication of catheter arteriography. 117 54

Forty-nine iliac artery autografts were used in the treatment of renovascular hypertension in 45 patients, including six children. The pathological process was fibromuscular dysplasia in 42, atherosclerosis in two, and Takayasu arteritis in one. The internal iliac artery was used as a graft in 39 patients. The common iliac bifurcation was used in two patients, and the external iliac artery in four patients. Common and external iliac artery continuity was restored with Dacron prostheses. Forty-three patients with 47 autografts have been followed up from one to ten years (average three years). Hypertension was cured or improved in 96% of the patients. Serial follow-up arteriograms as late as ten years after surgery have been obtained in 50% of the patients. No late occlusions occurred. Slight autograft dilation occurred seven years postoperatively in one child. Normal growth of the autograft was exhibited in the remaining five children. No evidence of dilation, aneurysm formation, or stenosis appeared in any other grafts, although one patient developed a new lesion distal to her graft.
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PMID:Aortorenal arterial autografts. 119 Oct 25

We report our experience in the treatment of 47 cases of renal hypertension patients with renovascular hypertension or hypertensive reno-parenchymal disease surgical therapy is essential and non-surgical therapy has its limitations. The necessity for an operation can be based on the determination of bilateral renal vein plasma renin values. Blood should be drawn from both renal veins in patients in an upright position. Surgical treatment usually produces excellent results in patients in whom renin activity on the side of the lesion is more than normal and more than 2 times that on the uninvolved side. It is advisable to perform an operation within 4 years of the onset of renal hypertension. Complete surgical cure of renal hypertension is accomplished more frequently in patients with fibromuscular dysplasia than in those atherosclerosis. The therapeutic effect of an operation in correcting hypertension is virtually the same, regardless of whether the arterial stenotic lesions are in the main renal artery or in the intrarenal arterial branches. We have found nephrectomy or dacron bypass graft to be the surgical procedure of choice in renovascular hypertension cases.
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PMID:Therapeutic experience in renal hypertension: response treatment in 47 cases. 123 71


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