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

Renal artery stenosis may play a significant role in the pathogenesis of secondary hypertension, renal dysfunction, and flash pulmonary edema. Currently correction of renal arterial inflow stenosis is reserved for resistant hypertension patients who have failed maximal medical therapy, have worsening renal function and/or unexplained proximal congestive failure. With the recent advances in minimally invasive percutaneous stent placement techniques, open surgical revascularization has been largely replaced by renal artery stenting. The potential benefit of revascularization seemed intuitive; however, the initial enthusiasm and rise in the number of percutaneous interventions have been tempered by many subsequent negative randomized clinical trials that failed to prove the proposed benefits of the percutaneous intervention. The negative randomized trial results have fallen under scrutiny due to trial design concerns and inconsistent outcomes of these studies compared to pivotal trials undertaken under US Food and Drug Administration scrutiny. Treatment of atherosclerotic renal artery occlusive disease has become one of the most debatable topics in the field of vascular disease. The results from recent randomized clinical trials of renal artery stenting have basically limited the utilization of the procedure in many centers, but not every clinical scenario was covered in those trials. There are potential areas for improvement focusing mainly on procedural details and patient selection with respect to catheter based treatment of atherosclerotic renal artery stenosis. We believe, limiting patient selection, enrollment criteria and outcomes measured functioned to reduce the benefit of renal artery stenosis stenting by not enrolling patients likely to benefit. Future studies incorporating potential procedural improvements and that include patients more likely to benefit from renal stenting than were included in ASTRAL and CORAL are needed to more carefully examine specific patient subgroups so that "the baby is not thrown out with the bath water." We also discuss several other concerns related to renal artery stenting which include diagnostic, procedure, indication, and reimbursement issues.
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PMID:Issues related to renal artery angioplasty and stenting. 2878 53

Resistant hypertension remains an important cause of heart failure. In this article, we describe a case of resistant hypertension in a 63-year-old woman leading to heart failure and marked morbidity. Her clinical course was characterized by chronic pleural effusions and recurrent hospitalizations with respiratory failure and flash pulmonary edema associated with heart failure with preserved ejection fraction. Her transthoracic echocardiogram showed severe concentric left hypertrophy and diastolic dysfunction. The clinical phenotype was secondary to resistant hypertension due to bilateral renal artery stenosis, and her blood pressure and heart failure resolved after successful renal artery angioplasty. This case demonstrates how heart failure with preserved ejection fraction due to renal artery stenosis can easily go unrecognized especially in patients with multiple comorbidities. The potentially curable nature of this condition clearly warrants consideration especially in patients with multiple risk factors for atherosclerotic vascular disease.
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PMID:Resistant Hypertension From Renal Artery Stenosis Leading to Heart Failure With Preserved Ejection Fraction. 3056 Jan 38

Spinal cord watershed ischemia is a rare phenomenon often associated with cardiac arrest, prolonged hypotension, and atherosclerotic disease. It can manifest as central necrosis with peripheral sparing in the transverse axis, and central lesion with rostral and caudal sparing in the longitudinal axis. Few reports provide detailed imaging findings of spinal cord watershed ischemia lesions. We present a patient who experienced watershed infarcts of the brain and spinal cord following prolonged hypotension due to blood loss after an aortic aneurysm repair. The patient experienced loss of neurologic function of the lower extremities and left arm that did not recover following spinal cord ischemia protocol. MRI revealed spinal cord watershed ischemia in both the longitudinal and axial planes with the point of maximal T2 signal hyperintensity in the central cord at T10-T11. Unique findings included zones of central maximal T2 signal hyperintensity with peripheral sparing, and moderate T2 intensity representing partial ischemia between regions of maximal T2 intensity unaffected peripheral regions. Thoracoabdominal computed tomography angiogram revealed extensive intraluminal thrombus and bilateral spinal artery occlusion from T8 to L2 and bilateral severe renal artery stenosis. T7 and L3 spinal arteries were patent. We suspect preexisting atherosclerotic disease played a significant role in the development of widespread watershed lesions following prolonged hypotension and resulted in a clinical and imaging presentation distinct from that seen with isolated anterior spinal artery occlusion. Our unique MRI findings portray a rarely documented pattern of spinal cord watershed ischemia and prompt questions about the role of anatomic idiosyncrasies and preexisting vascular disease in the development of spinal cord watershed ischemia.
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PMID:Spinal cord watershed infarction: Novel findings on magnetic resonance imaging. 3076 4

Secondary hypertension accounts for 5% to 10% of all hypertensive cases, and renal artery stenosis is one of the most common causes of secondary hypertension. Although atherosclerotic vascular disease and fibromuscular dysplasia are the leading causes of renal artery stenosis, there are other, rare etiologies, such as vasculitis and trauma. A partial nephrectomy is the standard of care treatment option for early stage renal carcinoma patients. Traumatic renal artery stenosis can occur during this surgical intervention, though it is a very rare adverse event, and only a few case reports have been reported in the literature. This report is the description of successful percutaneous treatment of accelerated hypertension secondary to traumatic renal artery stenosis after a partial nephrectomy.
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PMID:A rare and overlooked mechanical complication of partial nephrectomy: Accelerated hypertension due to renal artery stenosis. 3098 12

Atherosclerotic renal artery stenosis (ARAS) accounts for more than 90% of cases with renal artery stenosis, which is the recognized cause of secondary hypertension, renal dysfunction and acute pulmonary edema. It is estimated that about 15% of patients with hypertension also have different degrees of ARAS at the same time. Hypertension is known to be associated with the risk of atherosclerotic vascular disease; these two conditions usually co-exist and interact with each other. At present, many studies have focused on how to intervene ARAS correctly or just optimal medical therapy (OMT). For patients with severe ARAS, stent implantation seems to be able to receive better clinical benefits because it can avoid renal ischemic injury; however, it remains inconclusive whether stent implantation is suitable for the essential hypertension patients accompanied with mild to moderate ARAS. We speculate that renal artery revascularization may accelerate renal dysfunction in essential hypertensive patients accompanied with mild to moderate ARAS, especially when hypertension could not be controlled within the normal range after the revascularization.
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PMID:Revascularization may accelerate renal dysfunction in hypertensive patients with moderate atherosclerotic stenosis of renal arteries. 3259 Mar 23


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