Chronic renal artery occlusion: Nephrectomy versus revascularization

Oskin, Timothy C.; Hansen, Kimberley J.; Deitch, Jonathan; Craven, Timothy E.; Dean, Richard H.

doi:10.1016/s0741-5214(99)70355-1

Cited by 58 publications

(37 citation statements)

References 13 publications

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“…1 RAO can occur unnoticed and may, like renal artery stenosis (RAS), present itself clinically as a cause of arterial hypertension. 1 Historically, surgical revascularisation has been the standard therapy for RAO 2,3 or RAS in a solitary kidney. 4 Currently established treatments of RAO are either open surgery or conservative follow-up with medical antihypertensive therapy, whereas percutaneous transluminal renal angioplasty (PTRA) is an established treatment of RAS.…”

Section: Introductionmentioning

confidence: 99%

Sustained beneficial effects on blood pressure during long time retrospective follow-up after endovascular treatment of renal artery occlusion

Alhadad¹,

Mattiasson²,

Ivancev³

et al. 2004

J Hum Hypertens

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We retrospectively evaluated short-and long-term effects of percutaneous transluminal renal angioplasty (PTRA) with or without stent placement of renal artery occlusion (RAO) upon blood pressure (BP), serum (s)-creatinine, and the need for antihypertensive treatment in 34 RAO patients who underwent PTRA during 1996-2002. In 24/34 (71%) treatment was considered technically successful, 22/24 (92%) were treated with PTRA þ stent, two with only PTRA. Patients were followed for mean 2.6 (range 0-8) years, during which 14/34 (41%) patients died. In all 34 patients, systolic and diastolic BP (SBP and DBP) before treatment were 184730/95715 mmHg and had decreased at discharge (to 157721/80710 mmHg; Po0.001 for both SBP and DBP), and remained lower after 1 year (154720/ 8377 mmHg;Po0.001 for SBP and Po0.01 for DBP), and at last follow-up (148720/80712 mmHg; Po0.001 for both SBP and DBP). No changes occurred in s-creatinine or the number of antihypertensive drugs. Similar results were seen in the subgroup of 24/34 (71%) patients in whom treatment was technically successful. Among the 24 patients undergoing technically successful PTRA, absence of nephrosclerosis (P ¼ 0.035) and a shorter duration of hypertension (P ¼ 0.020) predicted favourable clinical outcome. No adverse effects upon s-creatinine or the need for antihypertensive medication were seen in patients in whom treatment was considered a technical failure. Seven of these patients were treated with PTRA of another renal artery than the occluded, or with embolisation. In conclusion, RAO can be treated with endovascular techniques. Technically successful results with decreasing blood pressure levels were obtained in 71% of patients.

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Section: Introductionmentioning

confidence: 99%

Sustained beneficial effects on blood pressure during long time retrospective follow-up after endovascular treatment of renal artery occlusion

Alhadad¹,

Mattiasson²,

Ivancev³

et al. 2004

J Hum Hypertens

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“…CER is generally unreliable when the affected GFR was low [19]. Nonetheless, this case appears to illustrates the value of CER in evaluating preservation of small kidney from renovascular disease and also the significance of careful dissection of renal artery during the surgery since intraoperative findings of normal distal artery as in the present case is often associated with favorable outcome [20].…”

Section: Case 3: No 10-181mentioning

confidence: 77%

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

et al. 2002

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Objective: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). Patients and Methods: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9–69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced ^99mTc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. Results: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. Conclusions: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.

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“…12 Prompt or even delayed revascularization may lead to complete or near complete recovery of renal function. 2,[4][5][6][7] It should be emphasized that after surgical or endovascular revascularization of ischemic nephropathy, up to 25% of patients experience improvement in renal function, 50% of patients have stabilization and up to 25% of patients note a deterioration of renal function. [13][14][15][16] Deterioration in renal function can be abrupt and progressive.…”

Section: Discussionmentioning

confidence: 99%

“…1 When atherosclerotic renal artery stenosis progresses to severe stenosis or occlusion, this may be clinically silent, or result in a worsening of hypertension or deterioration in renal function. 2,3 An abrupt onset of acute oliguric renal failure in a hypertensive patient with risk factors for systemic atherosclerosis should always raise a suspicion of global renal ischemia (bilateral renal artery stenosis or stenosis to a solitary functioning kidney). Prompt revascularization may prevent permanent dependence on renal replacement therapy.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous revascularization of occluded renal arteries in the setting of acute renal failure

et al. 2009

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Abstract:We report the case of a 60-year-old patient with acute renal failure and occluded bilateral renal arteries presenting with acute pulmonary edema and non-ST segment elevation myocardial infarction. The patient required renal replacement therapy with hemodialysis and was subsequently successfully treated with bilateral renal artery stent placement. Marked improvement in renal function was noted within 1 week with freedom from the need for renal replacement therapy at 4 months of follow-up.

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Chronic renal artery occlusion: Nephrectomy versus revascularization

Cited by 58 publications

References 13 publications

Sustained beneficial effects on blood pressure during long time retrospective follow-up after endovascular treatment of renal artery occlusion

Sustained beneficial effects on blood pressure during long time retrospective follow-up after endovascular treatment of renal artery occlusion

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

Percutaneous revascularization of occluded renal arteries in the setting of acute renal failure

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