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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Even in the absence of symptoms, peripheral arterial disease carries with it a significant risk of morbidity and mortality; thus, screening with the use of the ankle-brachial index is important in identifying patients at risk. Endovascular therapy in the lower extremities is continually evolving for treatment of patients with claudication symptoms or limb-threatening ischemia. Alternative treatments such as cryotherapy and the use of laser-assisted angioplasty hold much promise but need further investigation. In the case of renal artery stenosis and resulting hypertension, supportive clinical evidence is limited for renal revascularization despite the rationale for reducing cardiovascular risk. The current standard of care for significant carotid artery stenosis can include carotid stenting and carotid endarterectomy, but medical therapy may have a role also.
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PMID:Peripheral arterial disease: an overview of endovascular therapies and contemporary treatment strategies. 1691 24

Many patients with acute heart failure have marked hypertension and preserved left ventricular ejection fraction. In these patients, the heart failure usually does not result from transient systolic dysfunction or valvular abnormalities but rather results from diastolic dysfunction. Treatment of this condition includes control of hypertension, cautious diuresis, and, if necessary, ventilatory support. Further workup after the acute phase should be directed by the overall clinical picture. Other potential contributing factors, such as renal artery stenosis, valvular heart disease, and ischemia, should be strongly considered. Unfortunately, chronic therapy for diastolic heart failure has not yet been standardized due to the paucity of clinical trial data. Strict control of hypertension appears to be of paramount importance. Angiotensin-converting enzyme inhibitors or receptor blockers may be of benefit in preventing repeat hospitalizations.
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PMID:Acute heart failure with preserved systolic function. 1815 78

Vascular occlusive disease poses a threat to kidney viability, but whether the events leading to injury and eventual fibrosis actually entail reduced oxygenation and regional tissue ischemia is unknown. Answering this question has been difficult because of the lack of an adequate method to assess tissue oxygenation in humans. BOLD (blood oxygen-level-dependent) magnetic resonance imaging detects changes in tissue deoxyhemoglobin during maneuvers that affect oxygen consumption, therefore this technique was used to image and analyze cortical and medullary segments of 50 kidneys in 25 subjects undergoing magnetic resonance (MR) angiography to diagnose renal artery stenosis (RAS). Magnetic rate of relaxation (R2*) positively correlates with deoxyhemoglobin levels and was therefore used as a surrogate measure of tissue oxygenation. Furosemide was administered to examine the effect of inhibiting energy-dependent electrolyte transport on tissue oxygenation in subjects with renovascular disease. In 21 kidneys with normal nephrograms, administration of furosemide led to a 20% decrease in medullary R2* (P < 0.01) and an 11.2% decrease in cortical R2*. In normal-size kidneys downstream of high-grade renal arterial stenoses, R2* was elevated at baseline, but fell after furosemide. In contrast, atrophic kidneys beyond totally occluded renal arteries demonstrated low levels of R2* that did not change after furosemide. In kidneys with multiple arteries, localized renal artery stenoses produced focal elevations of R2*, suggesting areas of deoxyhemoglobin accumulation. These results suggest that BOLD MR coupled with a method to suppress tubular oxygen consumption can be used to evaluate regional tissue oxygenation in the human kidney affected by vascular occlusive disease.
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PMID:The use of magnetic resonance to evaluate tissue oxygenation in renal artery stenosis. 1828 64

We report a case of a 24-year-old woman with an unremarkable past medical history who was presented to the emergency department with acute onset of breathlessness and weakness of right lower limb. Clinical examination was suggestive of malignant hypertension with acute left ventricular failure and acute ischemia of right lower limb. Colour Doppler and CT findings were consistent with dissection of entire aorta with extension into its major branches. She died in less than 18 h after admission following cardiac tamponade. Autopsy revealed left renal artery stenosis with features of Takayasu's arteritis with intimal rupture in the abdominal aorta with Stanford type A dissection of aorta extending to all the major branches of aorta, and hemopericardium. This case demonstrates a rare example Takayasu's arteritis involving left renal artery leading to secondary hypertension presenting as malignant hypertension with fatal dissection of aorta with cardiac tamponade and emphasizes the varied presentations of this disease and importance of early diagnosis and interventions to prevent these fatal complications.
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PMID:Malignant hypertension, dissection of aorta, cardiac tamponade and monoparesis--unusual presentation of Takayasu's arteritis: clinicopathological correlation. 1837 65

Ischemia-reperfusion injury (IR) is a common and an important clinical cause of renal disease, such as renal transplantation, renal artery stenosis and following shock from any cause. Inflammatory reaction after IR is regulated by various kinds of mediators. Chemokines are major mediators of the inflammation, and regulate pro-inflammatory cytokine and adhesion molecule expression, and leukocyte infiltration and activation. Chemokines are the key players of inflammation, angiogenesis and fibrosis. These inflammatory processes mediated by chemokines were observed in not only experimental animal models, but also in human renal diseases with ischemic injury. A number of challenges of chemokine targeted therapy is trying to prevent the ischemic injury, and will give some beneficial effect on the injury.
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PMID:Roles of chemokines in renal ischemia/reperfusion injury. 1850 96

Congestive heart failure often occurs in patients with bilateral renal artery stenosis. Recently, Jacobson and Breyer, and Jacobson introduced the term "ischemic nephropathy", which implies critical bilateral involvement or global ischemia. Ischemic nephropathy is not only a cause of hypertension but also an important cause of end-stage renal disease. However, the aging kidney often show that the renal artery does not demonstrate stenosis of the main trunks, but stenosis of an atherosclerotic branch. We present a case of multiple atherosclerotic peripheral renal arteries, which might have caused ischemic nephropathy in an elderly hypertensive patient with advanced atherosclerosis.
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PMID:Ischemic nephropathy in an elderly patient. 1871 67

Takayasu arteritis (TA) is a large vessel vasculitis that usually affects young female patients during the second and third decades of life, but has been reported in children as young as 24 months of age. Aim of this report was to describe four children (two girls) with TA, as well as summarizing main published studies. The mean age at presentation of our cases was 11 years (range 8-15). Three patients were Caucasians and one Asian. Arterial hypertension was the commonest mode of presentation followed by systemic symptoms. Other related symptoms were due to ischemia and consisted of abdomen, chest, and limb pain. An abdominal bruit was noted in only one patient. Inflammation markers were always abnormal. Angiography was performed in all cases; left subclavian artery and common carotid artery were more frequently involved. Renal artery stenosis was observed in two patients. One boy was diagnosed as having an associated immune deficiency (Wiskott-Aldrich syndrome). Treatment modalities included prednisone (n = 4), methotrexate (n = 3), and mycophenolate mofetil (MMF) (n = 1). Surgery was required in two patients. Follow-up ranged from 3 to 10 years since diagnosis. In three cases antihypertensive drugs and methotrexate were stopped, and prednisone was reduced to 7.5 mg/day.
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PMID:Takayasu arteritis in children. 1882 74

Ischemic nephropathy describes progressive renal failure, defined by significantly reduced glomerular filtration rate, and may be due to renal artery stenosis (RAS), a narrowing of the renal artery. It is unclear whether ischemia is present during RAS since a decrease in renal blood flow (RBF), O(2) delivery, and O(2) consumption occurs. The present study tests the hypothesis that despite proportional changes in whole kidney O(2) delivery and consumption, acute progressive RAS leads to decreases in regional renal tissue O(2). Unilateral acute RAS was induced in eight pigs with an extravascular cuff. RBF was measured with an ultrasound flow probe. Cortical and medullary tissue oxygen (P(t(O(2)))) of the stenotic kidney was measured continuously with sensors during baseline, three sequentially graded decreases in RBF, and recovery. O(2) consumption decreased proportionally to O(2) delivery during the graded stenosis (19 +/- 10.8, 48.2 +/- 9.1, 58.9 +/- 4.7 vs. 15.1 +/- 5, 35.4 +/- 3.5, 57 +/- 2.3%, respectively) while arterial venous O(2) differences were unchanged. Acute RAS produced a sharp reduction in O(2) efficiency for sodium reabsorption (P < 0.01). Cortical (P(t(O(2)))) decreases are exceeded by medullary decreases during stenosis (34.8 +/- 1.3%). Decreases in tissue oxygenation, more pronounced in the medulla than the cortex, occur despite proportional reductions in O(2) delivery and consumption. This demonstrates for the first time that hypoxia is present in the early stages of RAS and suggests a role for hypoxia in the pathophysiology of this disease. Furthermore, the notion that arteriovenous shunting and increased stoichiometric energy requirements are potential contributors toward ensuing hypoxia with graded and progressive acute RAS cannot be excluded.
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PMID:Regional decreases in renal oxygenation during graded acute renal arterial stenosis: a case for renal ischemia. 1897 50

Renal artery stenosis (RAS) is often present in patients with severe hypertension and atherosclerotic vascular disease. In this setting it is important to screen patients for renovascular disease, e.g. with Duplex-ultrasound, CT- or MR-angiography. The challenge of treating these patients is to find the evidence proving that the RAS is responsible for hypertension and/or renal dysfunction. Measurement of the intra-arterial pressure gradient is necessary in order to determine hemodynamic relevance. On the other side, in these patients hypertension is often of primary and/or renoparenchymatous origin and is aggravated by a renovascular disease. This explains why hypertension cannot be cured even if a high grade stenosis has been removed. In addition, thromb- and cholesterol-embolic material is often mobilized during an invasive procedure and leads to renaparenchymatous ischemia which sustains hypertension after intervention. An individual evaluation of profit versus risk is important for the decision for or against an invasive procedure, especially since there is no sufficient evidence for a decrease of mortality after interventions of RAS. The optimal conservative treatment, including the treatment of atherosclerotic risk factors is recommended.
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PMID:[Hypertension in patients with renal artery stenosis]. 1909 16

The past decade has witnessed an evolution of the specialty of Nephrology in the United States to an interventional discipline. Traditionally, Interventional Nephrologists have focused on the venous side of an arteriovenous access. However, these specialists are beginning to include arterial disease related to renal patients under the purview of this specialty. Recent data have emphasized that inflow stenosis of an arteriovenous access frequently results in vascular access dysfunction. Peripheral vascular disease, resulting in distal hypoperfusion ischemia syndrome of the hand bearing the access, is similarly being recognized and managed more frequently by these experts. Two distinct entities, subclavian artery and renal artery stenosis, are also being addressed by interventional nephrologists. This article focuses on arterial interventions performed by interventional nephrologists and describes the epidemiology, techniques, and outcomes of arterial intervention as they relate to the care of patients with hemodialysis access and chronic kidney disease.
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PMID:Arterial interventions in arteriovenous access and chronic kidney disease: a role for interventional nephrologists. 1974 74


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