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

The accepted correct procedure for treating occlusive arterial diseases includes surgical disobstruction, CL as well as PTA. Combined non-surgical strategies are effective in about 60% of these patients. However, a high risk of rethrombosis despite from the prophylaxis with anticoagulants like heparin or antiplatelet drugs like ASA is proven, especially in patients with multi-segmental stenosis as well as in patients with extensive narrowing of the arteries. In these cases primary lesions (endangitis obliterans) or secondary lesions of the endothelium cause local depletion of plasminogen in the endothelium. Independent of the method used for reopening the vessel in these patients, a significant progression of the vessel disease and a high rethrombosis rate during longterm follow-up is observed. These results lead us to apply plasminogen locally to decrease the rate of rethrombosis. In patients suffering from stage III-IV (La Fontaine) including patients with multi-segmental stenosis as well as extended narrowing of the artery, PTA in combination with CL was performed. The catheter was placed as near as possible to the thrombus. In some cases the 'fibrinolyticum' could be injected directly into the thrombus. In these cases a bolus of 4,000 U/ml was locally infused, otherwise 1.0-1.5 million U urokinase per 24 hrs. were locally infused with heparin. In 28% (22 patients) no sufficient clinical response occurred using this combined therapy and plasminogen was applied locally. The following criteria supported our decision to include the patients in this study: 1. Insufficient response occurring after 12-24 hrs. of local infusion. 2. Following 6 bolus injections no reopening of the vessel occured within 60 minutes or the clinical response was insufficient due to rethrombosis. 3. Insufficient effects of lysis therapy after 2 hours and contraindication for a systemic fibrinolytic therapy (e.g. hypertension, age, etc.). 1,000 U plasminogen per ml were infused locally or 2,000 U up to 5,000 U plasminogen (in 5 to 10 ml 0.9% saline) were infused slowly (2-4 minutes infusion time) into the catheter in these patients 10 minutes after unsuccessful treatment with local urokinase therapy. Five minutes after administering plasminogen local intraarterial fibrinolytic therapy with urokinase was continued. No severe side effects due to this therapy were observed, although some patients suffered from acute pains in the peripheral segments of the arteries occurring immediately after infusion of plasminogen. In 16 of 22 patients a complete recanalization occurred and in 3 patients a satisfying clinical improvement was observed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Effectiveness of intraarterial plasminogen application in combination with percutaneous transluminal angioplasty (PTA) or catheter assisted lysis (CL) in patients with chronic peripheral occlusive disease of the lower limbs (POL). 296 85

Our experience on 371 patients studied with DSA for reno-adrenal pathology in the last two years is reported. The purpose of this study was the evaluation of real possibilities of DSA in comparison with conventional angiography, particularly to specify diagnostic space of venous versus arterial approach in this region of interest. In our experience, DSA by venous approach is indicated only as a screening method for nefrovascular hypertension or post-surgery, post-PTA and post-embolization controls; in all other cases, DSA by arterial approach is preferable for its superior diagnostic accuracy and lesser pharmacological invasivity, in comparison both with venous DSA and conventional angiography.
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PMID:[Digital subtraction angiography (DSA) of the renal-adrenal area. Methods of use and indications]. 391 54

Three patients developed reversible renal insufficiency after successfully performed PTA at the same time as their hypertension was beneficially influenced. The main cause of this complication probably is toxic effects of contrast medium in combination with the temporary occlusion of the renal artery during the PTA of kidneys with previously damaged parenchymal and impaired perfusion. During the phase of renal insufficiency contrast medium retention in the renal cortex was noted at computed tomography.
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PMID:Reversible renal insufficiency after percutaneous transluminal angioplasty (PTA) of renal artery stenosis. 623 39

PTA may be the most cost-effective approach to correctable renovascular hypertension. Successful PTA not only lowers the blood pressure, but may also preserve or improve renal function. Patients who are not ideal surgical risks should be considered for this approach if their blood pressure is not controlled or if side effects from antihypertensive drug therapy are disabling. PTA should be performed in consultation with, and with the back-up of, a vascular surgeon.
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PMID:Percutaneous transluminal angioplasty: an alternative treatment for renovascular hypertension. 699 42

The techniques and results of percutaneous transluminal angioplasty (TPA) of the renal arteries were evaluated in 20 hypertensive patients with 25 renal artery stenoses. Follow-up angiograms have been obtained in nine patients. Many patients had evidence of both essential and angiotensinogenic hypertension. Eleven patients had evidence of severe diffuse atherosclerotic disease, and nine patients had evidence of renal insufficiency. The mean systolic pressures before and after PTA were 203.80 and 150.30, respectively. The mean diastolic pressures before and after PTA were 117.45 and 85.95, respectively. Ten patients were cured. Six patients with long histories of hypertension and a recent increase in blood pressure were classified as having blood pressure easier to control with antihypertensive medication following PTA. Three patients failed to respond to PTA, and one patient was a technical failure. The advantages of this technique include avoidance of general anesthesia and a major surgical procedure, decreased cost, and a shortened hospital stay. The technique can be easily repeated if necessary, and future surgical intervention is not precluded if the method is unsuccessful.
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PMID:Percutaneous transluminal dilatation of the renal arteries: techniques and results. 738 40

Catheter-dilatation (percutaneous Transluminal Angioplasty=PTA) of renal artery stenoses can be applied successfully and without major risk even in patients with high operative risks. Therefore, the indication for the diagnostic evaluation of renal artery stenosis should be expanded to all patients suspected to have renovascular hypertension. Excretory urography combined with angiotomography offers the possibility to visualize the renal arteries and to either detect or exclude arterial stenosis. In the first part results of this procedure are presented. The bolus injection have been carried out on 415 patients without any serious side-effects. Using angiotomography 49 renal artery stenoses, 1 aneurysm and 1 AV fistula could be detected. Catheter-angiograms, angiotomograms and conventional rapid sequence urograms were compared in 91 patients. For angiotomography a sensitivity for the presence of renal artery stenosis of 93% and a specifity for the absence of arterial stenosis of 99% can be attained. In the second part, the results of PTA of renal artery stenoses in 35 patients are described. PTA was technically successful in 29 patients (83%). Three clinically silent complications are reported. In a mean follow-up period of 8,2-months, hypertension was normalized in 13 (45%) and improved in 10 (34%) patients. Renal insufficiency could be normalized in 7 out of 11 patients. These results make PTA the method of choice in treating renovascular hypertension. Only if this method is not applicable or technically not feasible, is the alternative for treatment surgical revascularization or conservative antihypertensive therapy.
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PMID:[New developments in diagnosis and treatment of renovascular hypertension (author's transl)]. 745 96

1. Conservative therapy of critical limb ischaemia either supports the effect of revascularisation procedures (thrombolysis, PTA, surgical reconstruction) or is employed in cases where instrumental intervention is no more possible. As a longterm control programme, the conservative approach reduces the number of local and general vascular complications. 2. The main physiological principles of conservative treatment are as follows: improvement of driving pressure (limb dependency, slow walking, mild temporary hypertension induced by isometric contraction of forearm muscles), decrease of vascular resistance (exercise, reflex dilatation by body heating, pharmacological vasodilators, prostanoids), microcirculatory improvement (oxygen inhalation, full recommended doses of drugs), prevention of oedema (calcium blocking agents not to be administered) and prevention of tissue destruction (anabolic hormones). It is of utmost importance to start vigorous therapy without delay when symptoms or signs of incipient critical ischaemia are detected; this should be followed by a life-long control and treatment programme. 3. Early beginning of therapy makes it usually possible to control incipient critical ischaemia effectively. The long term control and treatment programme contributes to a significant drop of relapses and mortality.
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PMID:[The present status of conservative therapy in critical lower limb ischemia]. 765 67

Besides antihypertensive drug treatment and reconstructive surgery, the percutaneous transluminal angioplasty became an established treatment modality for renal artery stenosis since the late 70's. The treatment aimed at curing the renovascular hypertension, at normalizing and improving of both compensated and decompensated renal insufficiency in order to avoid prolonged hemodialysis after acute renal failure. Endovascular procedures contributed significantly to reach a normotensive state, particularly in cases with renal artery stenosis concomitant with fibromuscular dysplasia and gives similar results as open surgical methods if certain morphological features are considered. However, surgery is generally more effective than endoluminal treatment when all forms of renal artery stenosis are considered together. This holds true in particular for ostial stenosis, complete obstruction of the renal artery, aneurysms and a multitude of rare renovascular diseases. Surgery should be first line treatment to preserve or improve the renal function. According to the pertinent literature, endovascular methods should be considered first for the treatment of renovascular hypertension. Despite the frequent repetition of potential advantages of PTA, a first direct comparison of both modalities demonstrated better primary results after surgical treatment. Even the total cost were similar since PTA requires frequent follow-up with short intervals necessitating secondary interventions.
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PMID:[Endovascular and open reconstructive surgery of renal artery lesions]. 771 52

In a retrospective analysis of 542 renal transplantations performed over a 10 years period, we diagnosed 25 cases of renal allograft artery stenosis that is a prevalence of 4.6%. The reason for angiography was persistent hypertension and/or renal insufficiency. An interventional procedure was performed in 16 patients (group 1): surgery in 5 and transluminal angioplasty (PTA) in 11. Nine other patients were medically treated (group 2). PTA or surgery was undertaken when a significant stenosis (> 70%) was found and when hypertension was severe (mean PAM = 123 +/- 11 mmHg). PTA was primarily performed when the anatomical situation of the stenosis was judged suitable. Medical treatment was chosen because the stenosis was assesses as not being severe enough or because was considered unsuitable for correction. Interventional treatment was successful in 77%. Long term results are shown in the table: in both 2 groups blood pressure decreased significantly at mean follow-up; the number of antihypertensive drugs decreased non significantly but are still necessary in the group 1. Mean serum creatinine is not significantly modified after treatment, there is no degradation of renal function in group 2 and no amelioration in group 1.
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PMID:[Stenosis of the renal artery of the transplant: comparison between interventional and medical treatment]. 775 69

Renovascular hypertension is one of the most common causes of secondary hypertension. Its early diagnosis is particularly important, firstly because it is one of the few potentially reversible causes of chronic renal failure. In many centers, including our own, renal angioplasty (PTA) or surgery is the treatment of choice for patients with renovascular hypertension. The aim of the study was the evaluation of the early and late results of PTA versus renovascular surgery. The diagnostic procedures and clinical course of renovascular hypertension were also analyzed. Among patients with renovascular hypertension treated in our Department during the 1981-1993 years, 89 patients (46 men, 43 women) were diagnosed and having renovascular hypertension (3% of all hypertensive patients). The average duration of hypertension in this group was 5 years. High incidence of accelerated hypertension (18%) and cardiovascular complications were observed: myocardial infarction in 20.2% of cases and stroke in 4.5%. The presence of renal failure was found in 22.5% of cases, hypokalemia in 11.2%, 38.3% of patients had changes in other arteries. Renal angioscintigraphy and captopril renal scintigraphy were performed in accordance with renal arteriography in 80% of patients. Arteriography showed unilateral renal artery stenosis in 78.7% of patients and bilateral - in 21.3%. The most common cause of renovascular hypertension in our material was atherosclerosis (65.2%). Fibromuscular dysplasia and Takayasu arteritis were diagnosed less frequently (25.8% and 9.0% respectively). Forty four patients were treated with PTA, 15 underwent surgical revascularization and 11 - unilateral nephrectomy. Early beneficial therapeutic effect (normalization or improvement of blood pressure control) was observed in 88.6% for PTA and 66.7% for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension--clinical observations and long-term follow-up]. 787 Dec


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