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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the reported case, coarctation of the aortic arch (Coa) was the cause of hypertonia. Coa diminishes the expected lifetime, and operative treatment is required. PTA is contradictory in the treatment of coarctation. In the reported case coarctation was located on the aortic arch, and because of the risk of the operation PTA was performed. The dilatation was successful, hypertension resolved, and there was no significant difference in the blood pressure on the extremities. 16 months after the dilatation the patient is symptomless. The result of this case indicates that PTA of the Coa of the aorta is feasible. More experience is needed to establish its role.
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PMID:[Percutaneous transluminal angioplasty in atypical aortic coarctation in an adult patient]. 160 88

In this study we report one case of abdominal aortic coarctation of unknown etiology, probably congenital or connatal, and two cases of aortoiliac occlusion in young non-diabetic patients, with an intrinsically small aortoiliac tree. These syndromes usually appear in young age; the principal clinical features are arterial insufficiency involving the lower extremities, often well tolerated, and hypertension. The differential diagnosis is with primitive atherosclerotic or inflammatory pathology. Echography and Doppler-echography can be helpful in the diagnosis, but intra arterial digital angiography is mandatory in confirming it. Medical therapy is usually unsuccessful, especially in controlling blood pressure, therefore surgery still remains the treatment of choice, together with PTA that can be applicable in selected cases.
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PMID:[Coarctation and hypoplasia of the abdominal aorta]. 179 57

Percutaneous transluminal coronary and renal angioplasty (PTA and Renal PTA) were performed during the same procedure in five of 100 patients who underwent PTCA between August 1989 and June 1990. All patients were male, with systemic hypertension (HT) with angina grade I to IV. The median age was 62 years (range 53 to 74). Three patients had controlled HT with 2 to 4 drugs and 2 were uncontrolled even after multiple antihypertensive treatment. Two patients were diabetic and the serum creatinine levels were normal except in one patient (1.9 mg/dL). Lesions more than 70% obstruction of luminal diameter were approached. Multivessel PTCA was done in one patient, multi-lesion in 2 and single lesion in other two. A total of 11 lesions were dilated, 4 in LAD, 5 in Cx and 2 in RCA (type A = 2, type B = 9). Complete revascularization was achieved in all cases. Five renal lesions were approached, 4 in the proximal third and one on the middle third. In 2 patients the blood pressure (BP) fell within normal limits without medication. In other 2 there was an improvement and were easily controlled with just one drug. One patient had no improvement and required multiple therapy to control it. The only complication observed was in a diabetic with previous abnormal serum creatinine who developed non-oliguric renal failure and returned to basal creatinine level at the third day post PTCA. In selected cases PTCA and renal PTA can be safely performed during the same procedure, with the advantage of cost reduction.
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PMID:[Coronary and renal percutaneous angioplasty performed in the same procedure. A report on 5 consecutive cases]. 183 49

One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n = 49) or surgical repair (SR; n = 39). The immediate success rate was 92.1% for SR and 69% for PTA. The long-term success rate was 81.5% for SR and 40.8% for PTA, with a follow-up period of 56.7 +/- 22.4 months (SR group) and 32 +/- 28.1 months (PTA group). PTA morbidity reached 28%, compared to 7.6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.
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PMID:Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty. 214 73

PTA is an established method of revascularization in a variety of medical conditions. It is performed for specific morphologic and clinical indications. PTA is the procedure of choice in Fontaine stage IIB through IV lower extremity ischemia due to iliac and/or femoropopliteal stenosis or short occlusion. Its role is less certain in infrapopliteal disease, although current studies have begun to establish long-term effectiveness. PTA is the procedure of choice for renal revascularization in renovascular hypertension due to fibromuscular disease or non-ostial atherosclerosis, selected cases of renal artery stenosis associated with renal insufficiency, and transplant renal artery stenosis. It is also useful in treating the renovascular component of complex hypertension and may be indicated in severe renal artery stenosis (75%-99%), even in the absence of clinically demonstrable RVHTN. PTA has limited applications in the venous system and only short-term success in the treatment of stenoses in dialysis access fistulas. PTA often serves as an important adjunct to surgical revascularization by providing improved inflow or outflow. PTA is the procedure of choice when anatomically feasible in subclavian steal syndrome. The role of PTA in carotid artery disease, particularly atheromatous disease of the internal carotid artery, is uncertain. The same may be said of PTA for vertebral artery stenosis, although the overwhelming majority of vertebral artery stenoses are morphologically suitable for PTA. PTA and surgery are both effective in the treatment of abdominal angina. There are more data available to verify the long-term patency of thromboendarterectomy and bypass grafts than PTA for mesenteric ischemia. However, since the technical success for PTA is high and since coronary co-morbidity is the most common cause of perioperative mortality in surgical series, PTA should be seriously considered as the procedure of first choice. Serious complications of PTA occur in approximately 5% of cases. Two to three percent of PTA patients have complications requiring surgery or causing a prolongation or alteration of hospital course. The morbidity, mortality, and cost associated with PTA are low. The discomfort is minor, and postprocedural recovery rapid. The major limitations of PTA include its unsuitability for some lesions (long-segment occlusions and stenoses, orifice lesions, eccentric lesions) and postangioplasty restenosis. These problems are being addressed by ongoing laboratory and clinical research. In the near future, it is likely that endoluminal transmural sonography of the vessel wall will help guide our interventions.
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PMID:Noncoronary angioplasty. 252 45

Following a renal PTA a 63-year-old man developed a multisystem illness caused by disseminated cholesterol embolism. The clinical manifestations were changing myalgia, peripheral ischaemia, livedo reticularis, episodic hypertension, eosinophilia and rapidly progressive renal insufficiency. The diagnosis was made on the clinical picture and confirmed by skin biopsy. Ultimately, chronic intermittent haemodialysis was necessary. There is no specific treatment available for this disease. It is possible that this complication occurs more frequently, but often remains subclinical.
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PMID:[Terminal kidney insufficiency caused by disseminated cholesterol emboli as a complication of intra-arterial manipulation]. 252 70

Renovascular hypertension is caused by renovascular disease and it can be potentially cured by ablative or reconstructive operation or PTA. The incidence of renovascular hypertension is 1 to 2 per cent among nonselected hypertensive patients. Renovascular disease in hypertensive patients is progressive in 20 to 40 per cent. The diagnosis of renovascular hypertension can only be made retrospectively after successful intervention. The accuracy of all tests for the determination of the functional significance of a stenosis before intervention remains limited. It has been demonstrated that medical therapy, reconstructive surgical treatment and PTA each can effectively lower high blood pressure. Although medical therapy has been considerably improved because of the development of new drugs, it should be recognized that medical management does not prevent the natural progression of renovascular disease. Therefore, renovascular hypertension is best treated by correction of the underlying renal arterial stenosis. Improvements in surgical management include improved selection of patients for surgical treatment, increased beneficial blood pressure response rates in 70 to 95 per cent of the patients and decreased surgical mortality rates of less than 5 per cent. The anatomic failure rates have been reduced because of the increase in surgical expertise, the use of autologous materials for bypass, the avoidance of combined procedures in the event of concomitant aortoiliac disease, the use of extra-anatomic reconstructions when appropriate and the introduction of extra-corporeal reconstruction and autotransplantation. PTA has evolved as a relatively safe and effective method in the treatment of renovascular hypertension. However, complications do occur and orificial arteriosclerotic lesions and renal arterial branch lesions should not be considered for angioplasty. At present, the question of whether renovascular surgical treatment or PTA should be the treatment of choice cannot be answered completely. Treatment of renovascular hypertension should be accommodated to each patient.
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PMID:Renovascular hypertension. 268 52

To assess the diagnostic and prognostic value of renal venous renin levels in renovascular hypertension, 95 patients with severe unilateral renal artery stenosis were studied. Surgery (n = 52) or percutaneous transluminal dilation (n = 43) were done irrespective of renal venous renin levels. Lateralization of renin secretion as assessed by the PRA ratio and the renin secretion index was found in the majority of patients (66% and 88%, respectively). Patients with fibromuscular hyperplasia had more frequently PRA ratios less than 1.5 than those with arteriosclerotic stenosis (p less than 0.05). The renin secretion index proved to have a higher sensitivity (92%) and predictive value (92%) for a successful outcome of both surgery and PTA than the PRA ratio (69% and 89%, respectively), while the specificity was the same with both parameters (42% and 43%, respectively). The contralateral suppression index was most specific in predicting an unfavorable outcome. However, with all ratios used, a considerable number of false-negative and false-positive tests were observed both with surgery and PTA, a finding limiting the value of the method in selecting patients for these interventions. Other factors, such as age of the patient, kidney function and the underlying arterial disease turned out to be equally important prognostic factors. Thus, although cure after both surgery and PTA is more likely in the presence of lateralized renin secretion and contralateral suppression, the method does not allow to exclude patients with severe renal artery stenosis, hypertension and negative renal venous renin tests from these interventions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal venous renin determinations in renovascular hypertension. Diagnostic and prognostic value in unilateral renal artery stenosis treated by surgery or percutaneous transluminal angioplasty. 294 11

Over a 10 year period, 17 children received treatment for renovascular hypertension. A stenosis of the main renal artery was demonstrated in 10 patients (bilateral involvement in two) and a branch artery in 7. Fifteen of the 16 patients available for follow up are normotensive after a mean of 3.7 years. The initial treatment choice consisted of nephrectomy (1 patient), partial nephrectomy (1 patient), ligation of a branch artery (1 patient), surgical angioplasty (3 patients), autotransplantation (6 patients), and percutaneous transluminal balloon angioplasty (7 patients). Six patients required secondary surgical procedures (4 nephrectomy, 1 surgical angioplasty and 1 autotransplantation) before the blood pressure was normalised. Transluminal balloon angioplasty was attempted in seven patients but was successful in only two with main renal artery stenoses. Treatment choices have increased for patients with renal artery stenosis lesions and increasing experience and assessment of techniques such as PTA are required.
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PMID:Renovascular hypertension: treatment choices. 294 76

A 12 year old girl with severe arterial hypertension was found to have neurofibromatosis associated bilateral stenoses of the main renal arteries and elevated plasma renin activity in the right main renal vein. Antihypertensive treatment was unable to normalize blood pressure. PTA of the right renal artery from a left axillary approach resulted in normalization of blood pressure and peripheral plasma renin activity. PTA seems to be an effective and safe method for treatment even of complicated forms of renal artery stenosis.
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PMID:Treatment of neurofibromatosis associated renal artery stenosis with hypertension by percutaneous transluminal angioplasty. 294 78


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