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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Atherosclerotic renal artery stenosis is the most common disease of the renal arteries and may lead to ischemic renal disease and hypertension. A close relationship exists between renal and cardiovascular disease, as they often occur concomitantly, and abnormalities in either system can cause disease and determine clinical outcome in the other. Renovascular disease is gaining recognition as a potentially important risk factor for cardiovascular morbidity and mortality. This article explores the association between atherosclerotic renal artery stenosis and the cardiovascular system.
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PMID:Renal artery stenosis and cardiovascular risk. 1734 96

Atherosclerotic renal artery stenosis (ARAS) is associated with hypertension, ischemic nephropathy, and high cardiovascular risk. We review the data on revascularization of the renal artery by percutaneous transluminal renal angioplasty (PTRA) and pharmacological therapy. In patients with severe ARAS and poorly controlled hypertension, PTRA can improve blood pressure control. In patients with rapid renal function loss and severe ARAS, PTRA can improve short-term renal function, but there is no evidence for long-term renoprotection. Recent evidence indicates that ARAS, and incidental renal artery stenosis, considerably increases cardiovascular risk, independent of blood pressure, renal function, and prevalent risk factors. This suggests that revascularization might potentially improve overall prognosis, but no data are available currently. The high cardiovascular risk warrants aggressive pharmacological treatment to prevent progression of the generalized vascular disorder. Ongoing trials will show whether revascularization has added, long-term effects on blood pressure, renal function, and cardiovascular prognosis.
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PMID:Atherosclerotic renovascular disease and renal impairment: can we predict the effect of intervention? 1744 26

Atherosclerotic renal artery stenosis (RAS) is relatively common and often associated with hypertension and progressive renal insufficiency. Technical improvements of interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization. Sometimes an endovascular procedure for (RAS) may fail. We report 3 cases successfully treated with laparoscopic assisted aortorenal bypass using an endovascular graft.
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PMID:Laparoscopy-assisted hybrid technique for renal revascularization using an endovascular graft: report of three cases. 1757 21

Atherosclerotic renal artery stenosis may result in hypertension and ischemic nephropathy. Renal artery endovascular stenting has emerged as current therapy; however, the percentage of patients who benefit from this procedure is still not well established. The authors studied 116 hypertensive patients with atherosclerotic renovascular stenosis who underwent successful renal artery stenting for the first time. At 1 year, there was a significant overall decrease in blood pressure in the group after stenting; however, there was no change in renal function. Also, no significant change in the number of antihypertensive drugs was noted. Blood pressure improved in 55% of the patients, worsened in 14%, and remained unchanged in 31%. Renal function improved in 16% of the patients, worsened in 30%, and remained stable in 54%. In relation to blood pressure control, patients with resistant or difficult-to-control hypertension showed the most improvement in blood pressure control after stenting.
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PMID:Use of endovascular stents in atherosclerotic renovascular stenosis: blood pressure and renal function changes in hypertensive patients. 1767 82

The most common cause of obstructive renal artery disease is atherosclerosis, accounting for 90 % of cases of renal artery stenosis. Atherosclerotic renal artery stenosis can be associated with renovascular hypertension, ischemic nephropathy, or both or it may occur alone. The prevalence of atherosclerotic renal artery stenosis among hypertensive patients is estimated between 1 and 5 %, but the frequency rises among patients with refractory hypertension (20 %) coronary heart disease (15 to 20 %) or peripheral arterial disease (30 to 40 %). The gold standard for diagnosing renal artery disease is contrast renal arteriography. MR angiography, CT angiography and color duplex ultrasonography have the highest sensitivity and specifity among the non invasive screening methods. Therapy is based on consequent medical treatment of hypertension, antiplatelet therapy and modification of risk factors for atherosclerosis. Revascularisation is advised in patients with severe hypertension, in patients with pulmonary edema and cases of acute worsening of renal function. Percutaneous angioplasty with stent implantation is the method of choice for revascularisation. The prognosis of patients with atherosclerotic renal artery stenosis is determined by cardiovascular and renal complications.
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PMID:[Atherosclerotic renal artery stenosis]. 1798 55

Atherosclerotic renal artery stenosis (ARAS) is a growing dilemma. The condition is increasingly common and can promulgate hypertension and result in renal failure. However, patients with ARAS generally die owing to their coronaries or cerebral vessels. Intervention, by stenting or angioplasty is beloved and believed, but not proved. The American Heart Association has recently published guidelines regarding patients at high risk for ARAS who are potential candidates for revascularisation. Since this phraseology includes practically every patient with atherosclerosis, these guidelines appear ill advised.
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PMID:Commentary: Shoot the renals! 1800 84

Atherosclerotic renal artery stenosis (ARAS) is an important cause of renal dysfunction and secondary hypertension, and is associated with adverse cardiovascular events and increased mortality. The natural history of ARAS is characterized by anatomic disease progression and/or renal dysfunction in only a minority of patients. Medical therapy for ARAS is directed primarily toward blood pressure control and cardiovascular risk factor reduction. Renal artery revascularization is an additional treatment option for ARAS associated with ischemic nephropathy or severe, poorly controlled hypertension despite aggressive medical therapy. Unfortunately, the benefits associated with revascularization versus medical therapy alone remain unproven. Renal artery revascularization may be accomplished through open surgical revascularization or angioplasty and stenting. Although surgical renal revascularization is associated with more durable results and relatively lower risk for postoperative renal function decline, the increased risk of death or major complications associated with this management approach limit its use in patients with significant comorbidities. Renal artery angioplasty and stenting is being utilized with increasing frequency but is of uncertain benefit and is associated with rates of post-intervention renal function improvement and deterioration that are approximately equal. Renal function outcomes associated with angioplasty and stenting may be improved through a selective treatment approach and utilization of distal embolic protection. Renal artery revascularization represents the only treatment alternative for patients unresponsive to medical management, and is therefore the ''treatment of choice'' in this select group. Results of ongoing randomized trials are eagerly anticipated and may provide useful guidance for future management of ARAS.
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PMID:Revascularization for atherosclerotic renal artery stenosis: the treatment of choice? 1867 Mar 77

Atherosclerotic renal artery stenosis (RAS) is the most common primary disease of the renal arteries and results in renovascular hypertension and ischemic nephropathy. Ischemic nephropathy from atherosclerotic RAS is increasingly recognized as a cause of chronic kidney disease (CKD) and in severe cases can lead to end-stage renal disease. The exact prevalence of atherosclerotic RAS is unknown because the disease is often asymptomatic and few are screened unless they have significant traditional cardiac risk factors or symptoms. A high prevalence of atherosclerotic RAS is seen in patients with advanced age, congestive heart failure, and extrarenal atherosclerosis. The primary reason for diagnosing ischemic nephropathy from renovascular disease is that the loss of kidney function is potentially reversible through treatment of the occlusion with surgical revascularization or percutaneous transluminal renal angioplasty. However, the benefits of revascularization have to be considered in the context of other comorbid disease and remain controversial. There are several tests available for the screening and diagnosis of atherosclerotic RAS; however, the diagnostic test of choice should be based on patient factors and institutional expertise because the best test is the one performed most often at the individual medical facility.
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PMID:Renal artery stenosis and chronic ischemic nephropathy: epidemiology and diagnosis. 1880 81

Atherosclerotic renal artery stenosis is often associated with diffuse atherosclerotic disease and consequently an increased cardiovascular morbidity and mortality. Despite evidence of only moderate clinical benefit in comparison with medical treatment to control the blood pressure and to prevent renal failure, renal endovascular revascularisation has become more and more popular. The decision to treat an atherosclerotic renal stenosis by revascularisation should be taken only after a close examination of the hemodynamic impact of the stenosis, the renal function, the severity of hypertension and the quality of blood pressure control achieved by the medical treatment.
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PMID:[Atherosclerotic renal stenosis: indications for revascularisation]. 1884 20

Atherosclerotic renal artery stenosis is the most common cause of renovascular hypertension. Primary treatment of renal artery stenosis includes renal artery balloon angioplasty and, in some cases, renal artery stenting. However, in-stent restenosis occurs in 11% to 39% of patients thus treated. Herein, we report the case of a 76-year-old woman whose left-sided renal artery stenosis had been treated by means of renal artery stenting. She later presented at our institution with flash pulmonary edema that was caused by in-stent restenosis. We successfully treated the patient with cutting-balloon angioplasty and cryoplasty of the in-stent restenosis. To our knowledge, this is the 1st report of the use of cryotherapy to treat in-stent renal artery stenosis.
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PMID:First use of cryoplasty to treat in-stent renal artery restenosis. 1915 53


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