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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The value of early films during a urogram in the investigation of arterial hypertension was investigated (402 urograms on unselected hypertensives, with arteriographic examination in 80). The diagnostic accuracy in cases of proven unilateral reno-vascular disease was 58%, signs suggestive of renal artery stenosis were found in 6.5% of the total material. Possible causes of the low degree of accuracy are discussed.
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PMID:[The value of early urographic films in the investigation of arterial hypertension (author's transl)]. 14 27

Investigations for renal artery stenosis have been greatly facilitated by advances in imaging techniques. Intravenous digital subtraction angiography is now performed in all patients with progressive, drug-resistant hypertension associated with aorto-iliac lesions or with renal impairment induced by angiotensin-converting enzyme inhibitors. Yet the finding of hypertension with renal artery stenosis is not enough to make the diagnosis of renovascular hypertension, this term being reserved to hypertension reversible by revascularization. The selection of patients who may benefit from revascularization rests on urography to explore the excretory and endocrine functions of the ischaemic kidney, as well as on scintigraphy and measurement of renin levels in renal veins before and after administration of captopril. The functional data are completed by vascular exploration which helps in evaluating the usefulness and safety of revascularization: repercussions of hypertension on target organs and extension of the vascular disease to other territories. Revascularization as first-line treatment consists of percutaneous transluminal dilatation; surgery must be reserved to difficult cases, such as arterial obliteration or failed dilatation.
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PMID:[Renovascular hypertension: diagnostic and therapeutic strategy]. 141 Aug 86

The effectiveness of single-dose captopril test (CP-T) and captopril renal scintigraphy with 99mTc-DTPA (CP-RG) in the diagnosis of renovascular hypertension (RVH) was evaluated in 27 patients with (Group I, 16 patients) or without (Group II, 11 patients) renal vascular disease. Group I consisted of RVH in 8 patients (bilateral in 3, unilateral in 5), arteriovenous malformation in 3, renal artery aneurysm in 4, including 2 with essential hypertension, and asymptomatic renal artery stenosis in 1. Group II consisted of 6 hypertensive patients (2 with essential hypertension and 4 with renal hypertension) and 5 normotensive patients. Sensitivity of CP-T and CP-RG in the diagnosis of RVH was 29% (2/7) and 86% (6/7), respectively, indicating the latter was more sensitive than the former. In 3 patients with bilateral RVH, positive response in CP-RG was observed only in the unilateral kidney. Specificity of CP-T and CP-RG was 86% (6/7) and 100% (5/5), respectively in Group I, 100% (8/8) and 83% (5/6), respectively in 16 hypertensive patients. CP-T and CP-RG before and after the treatment of RVH were evaluated in 4 patients. The change of positive response in CP-T and CP-RG into negative after percutaneous transluminal renal angioplasty (PTA) or surgery were found in 3, all followed by a fall in blood pressure, which was not observed in the other patient with positive response after PTA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Single-dose captopril test and captopril renal scintigraphy in the evaluation of renovascular hypertension]. 143 70

Percutaneous transluminal renal angioplasty (PTRA) is generally considered of little benefit in the treatment of ostial renal artery stenosis. This report contains long-term follow-up (> 12 months in all patients; mean follow-up, 38 months) for 110 patients who underwent PTRA for treatment of ostial renal artery stenosis. There was no significant difference in patient benefit related to bilaterality or multiplicity of lesions treated or to renal function before angioplasty (P > .1). Although there was no statistically significant difference in benefit among groups of patients who received treatment, certain trends were apparent. The least benefit occurred in patients with insulin-dependent diabetes and those with symptoms or history of vascular disease in another organ system. Treatment of lesions with proportionately larger balloons did not result in greater benefit. Restenoses were redilated in 16 patients for whom initial treatment failed. Eleven of these were ostial restenoses. The ostial stenosis in one patient was redilated a second time. At the end of follow-up, primary, secondary, and tertiary clinical benefits were 48%, 57%, and 58%, respectively. This was not statistically different (P = .14) from a control group of 94 patients with nonostial stenoses who had 68% long-term benefit. The authors conclude that ostial renal artery stenosis is not a contraindication to PTRA, and balloon angioplasty can play an important role in blood pressure control in this patient population.
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PMID:Long-term results of angioplasty in 110 patients with renal artery stenosis. 144 23

A retrospective analysis was done on 235 hypertensive patients undergoing renal arteriography. Of the 85 patients with renal artery stenosis 50 underwent 56 operations or angioplasties and have been followed up for at least a year. 41 (73%) of these procedures were curative or led to improved blood-pressure control. These results make it worthwhile identifying hypertensive patients with renal artery stenosis who may benefit from surgery or angioplasty. Vascular disease, epigastric bruit, and impaired renal function were commoner in the renal artery stenosis patients than in the 81 with normal arteriograms, but there were no features pathognomonic of stenosis. Intravenous urography had a sensitivity of 83% and a specificity of 69.5% in identifying renal artery stenosis; those for isotope renography were 90.5% and 38.5%, respectively. Divided renal vein renins did not predict the outcome of intervention. Arteriography should, if there are no contraindications to intervention, be the first and definitive investigation when renal artery stenosis is suspected--for instance, in hypertensive patients with accelerated or malignant hypertension, those whose blood pressure is poorly controlled by multiple therapy, and those who have had recent deterioration in blood-pressure control or renal function.
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PMID:Detection and investigation of renal artery stenosis. 241 18

Hypertension constitutes a major health problem and the challenge is to identify patients having 'surgically' curable renal vascular disease among the majority with so-called essential hypertension. The best of unsatisfactory diagnostic tests are renography and plasma renin activity both before and during angiotensin II blockade. The necessity of better screening tests has increased because of the recent advances in surgical techniques and especially percutaneous transluminal renal angioplasty. The latter has definitely become the method of choice for correction of suspected hemodynamically significant artery stenoses whenever technically feasible. With improved angioplasty techniques the risk of treating renal artery stenosis without hemodynamic and clinical importance (so-called cosmetic repair) has increased. Unfortunately randomized trials including surgery versus angioplasty are not available. It should be kept in mind that only after correction of the stenosis is achieved and the blood pressure has become normal, can the diagnosis of renovascular hypertension be made with certainty.
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PMID:Renovascular hypertension. Diagnosis and intervention. 252 9

Sixty-four selected hypertensive patients, aged 17-45 years, were evaluated for renovascular hypertension. They were studied with 99mTC-DTPA Dynamic Renal Scanning (DRS) and Intravenous Digital Subtraction Angiography (IV-DSA). Intra-arterial DSA was further performed to demonstrate renal vascular anatomy in all disputable cases. Agreement of diagnosis occurred in 58 patients (32 with renal artery stenosis). There was one false positive with DRS and one false positive with IV-DSA. In another four patients with proven renovascular disease, IV-DSA was positive while DRS negative, but in two of them the stenotic lesion was considered insignificant, as they failed to respond to percutaneous transluminal dilatation (PTA). In contrast, nearly all patients whose hypertension improved after PTA or surgery had positive DRS and greater than 40% reduction of relative function of the affected kidney. IV-DSA yielded better results than DRS in the detection of renal arterial stenosis (especially whenever bilateral stenosis or rich collateral circulation was present), but DRS showed better correlation with the functional significance of a certain vascular abnormality. Thus the combination of the two methods seems to be a reasonable diagnostic approach to hypertensive patients with the aim of selecting those with curable hypertension due to renal vascular disease.
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PMID:Investigation of renovascular hypertension with 99mTC-DTPA dynamic renal scanning and digital subtraction angiography. 268 92

Thirty-three patients with renal angiographic evidence of significant renal artery stenosis were referred for percutaneous transluminal angioplasty. The indications were poorly controlled hypertension (n = 13) or hypertension associated with deteriorating renal function (n = 20). Their mean age was 56 (23-73) years (12 males, 21 females). Causes of the renal artery stenosis were fibromuscular dysplasia (n = 8) and atheromatous changes (n = 25). Four patients were excluded, three due to technical failure. Forty-five angioplasties were performed in 29 patients with a mean observation period after angioplasty of 18 (one to 60) months. During this period eight patients (28 per cent) had a diastolic blood pressure of less than 90 mmHg without antihypertensive drugs, a further 15 patients (52 per cent) had improved blood pressure control with a significant reduction in the number and amount of antihypertensive drugs, but six patients (20 per cent) showed no improvement in blood pressure. Hypertension associated with the stenosis of fibromuscular dysplasia responded better to angioplasty than hypertension associated with atheromatous renal artery stenosis. Improvement in renal function was noted in eight patients with no change in 16 patients. Two patients with end-stage renal failure and atheromatous intrarenal vascular disease became dialysis dependent within four weeks of the procedure. One major and four minor complications occurred but there were no deaths related to angioplasty. Together with results from other centres this study indicates that percutaneous transluminal angioplasty should be considered the initial treatment choice for all patients with renovascular hypertension due to fibromuscular dysplasia and atheromatous renal artery stenosis.
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PMID:Percutaneous transluminal angioplasty improves blood pressure and renal function in renovascular hypertension. 295 95

Percutaneous transluminal angioplasty (PTA) was eventually successful in a patient with renal artery stenosis due to neurofibromatosis. Although the immediate postangioplasty appearance showed little improvement, the residual stenosis has completely resolved at 5 months. Delayed response to PTA has been previously documented in other types of vascular disease. Its occurrence in renal artery stenosis due to neurofibromatosis emphasizes the importance of long-term follow-up and may be a factor in the poor short-term results that some have reported for PTA in patients with this condition.
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PMID:Percutaneous transluminal angioplasty: delayed response in neurofibromatosis. 297 Dec 40

To support our contention that the Wistar-Furth rat is resistant to mineralocorticoid hypertension, we assessed the effects of deoxycorticosterone (DOC) administration or renal artery stenosis on the development of hypertension in the Sprague-Dawley and Wistar-Furth rat strains. Weekly administration of mineralocorticoid in the form of DOC pivalate resulted in rapid, severe hypertensive cardiovascular disease in Sprague-Dawley rats. Within 5 weeks the mean conscious systolic blood pressures in steroid-treated and control rats were 186 +/- 4 and 118 +/- 5 mm Hg, respectively. In contrast, blood pressures of Wistar-Furth rats were only moderately elevated, even after 10 weeks of DOC pivalate administration (136 +/- 2 vs 116 +/- 2 mm Hg for controls). Furthermore, none of the steroid-treated Wistar-Furth animals exhibited cardiovascular lesions. In parallel studies, littermates of these rat strains were subjected to renal artery stenosis and blood pressures were determined weekly in conscious rats. Silver clip constriction of the left renal artery, in the presence of the contralateral kidney, resulted in a rapid, sustained elevation of blood pressure in both Sprague-Dawley and Wistar-Furth rat strains (177 +/- 4 and 176 +/- 5 mm Hg, respectively). Corticosteroid levels were also determined in DOC-treated Sprague-Dawley and Wistar-Furth rats. The regimen employed resulted in a 10-fold increase in DOC levels as compared with controls, and the levels achieved were comparable in both strains. Thus, the Wistar-Furth rat appears to be selectively resistant to mineralocorticoid hypertensive vascular disease and thus affords a model for studying mechanisms of steroid hypertension.
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PMID:Resistance to mineralocorticoid-induced hypertensive vascular disease. 361 Feb 93


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