To determine whether the varicocele results from collateral circulation partially replacing an obstructed left renal vein, we developed a scintigraphic technique that provides not only information about the velocity of retrograde flow in the testicular veins but also quantitative information about the size of the varicocele. The reliability of this method was assessed by comparison with the results of phlebography and the clinical diagnosis in 104 patients. Furthermore, the diameter of the left testicular vein was determined on the phlebogram. Good correlation was found among the velocity of the retrograde flow in the left testicular vein, the size of the varicocele and the diameter of the left testicular vein.
We studied the frequency of restenosis and the effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure (BP) and particularly on renal function in all patients in whom successful dilatation was performed. Restenosis was found in 42% of the patients with an atherosclerotic renal artery stenosis and in 22% of the patients with fibromuscular dysplasia. BP improvement was seen in 70–80% of the patients with unilateral stenosis or with successful bilateral dilatation (group I) whereas only seldom was an effect on BP observed in patients with more complicated disease, such as those with an occlusion of the contralateral artery (group II). Remarkably, however, both in group I and in group II, in about half of the patients an improvement in renal function was found, even 2–3 years after the procedure. Our results thus indicate that PTRA can be useful in preservation or even improvement of renal function, even if no effect on blood pressure can be expected.
In this paper we report on a patient with accelerated hypertension associated with a totally obstructed right renal artery and a severe constricted left one. In this ‘two-kidney, two-clip’ model of renovascular hypertension, captopril in combination with severe sodium restriction was not effective, possibly as a consequence of overloading with sodium and water due to a low renal perfusion pressure at the left side. Transluminal renal artery dilatation changed this ‘two-kidney, two-clip’ into a ‘two-kidney, one-clip’ model of renovascular hypertension, which subsequently responded well to captopril treatment. Some pathophysiological mechanisms involved are briefly discussed.
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