Farbduplexsonographische Darstellbarkeit von Nierenarterien und Erkennung hämodynamisch relevanter Nierenarterienstenosen

Zeller, Th.; Frank, Ulrich; Späth, M; Roskamm, H.

doi:10.1055/s-2001-15287

Cited by 42 publications

(13 citation statements)

References 19 publications

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“…Diagnosis was made in most cases by duplex ultrasound (Ultramark 9 HDI and HDI 3000, ATL, Bothell). Unilateral RAS were classified as hemodynamically relevant (≥ 70%) when the side difference of the intrarenal RI according to Pourcelot (systolic peak flow velocity − end‐diastolic flow velocity = systolic peak flow velocity) was more than 0.05 as described previously [36] and confirmed by intra‐arterial angiography performed prior to intervention. Indication for intervention was predefined as atherosclerotic renal artery stenosis ≥ 70% in patients with hypertension with or without renal insufficiency.…”

Section: Methodsmentioning

confidence: 99%

Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis

Zeller

Müller

Frank

et al. 2003

Cathet Cardio Intervent

111

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Atherosclerotic renal artery stenosis (ARAS) may lead to deterioration of renal function or hypertension. The clinical outcome after stent angioplasty of ARAS on renal function and blood pressure control in patients with diabetes and nephrosclerosis is the subject of some controversy. We have analyzed the results of our single-center experience with stent angioplasty for severe (>/= 70%) ostial ARAS and present here the results of a subgroup analysis of those patients who had diabetes mellitus and nephrosclerosis. From 1996 to 2001, 241 patients underwent stent angioplasty for the treatment of ARAS at our center. Of these, 99 patients had diabetes mellitus (41%) and 176 patients (73%) had nephrosclerosis defined as intrarenal resistance index (RI) >/= 0.7 diagnosed by duplex ultrasound. All lesions (n = 355) were treated successfully. Mean blood pressure at baseline was comparable and significantly improved immediately after the intervention in all groups (nondiabetics: 102 +/- 12 to 93 +/- 10 mm Hg; diabetics: 102 +/- 14 to 93 +/- 11 mm Hg; RI < 0.7: 105 +/- 13 to 95 +/- 10 mm Hg; RI = 0.7-0.8: 100 +/- 12 to 92 +/- 10 mm Hg; RI > 0.8: 102 +/- 15 to 92 +/- 11 mm Hg; P < 0.0001 each). Baseline serum creatinine was not significantly lower in nondiabetics compared to diabetics (1.46 +/- 0.9 vs. 1.62 +/- 1.2 mg %; P < 0.05) and increased in patients with nephrosclerosis (RI < 0.7: 1.18 +/- 0.6 mg %; RI = 0.7-0.8: 1.57 +/- 1.1 mg %; RI > 0.8: 1.96 +/- 1.6 mg %). Except for patients without nephrosclerosis who had a normal baseline creatinine, serum creatinine decreased significantly in all subgroups during follow-up. Stent angioplasty of ARAS offers favorable acute and long-term clinical results for the preservation of the renal function and for blood pressure control in patients with diabetes mellitus and nephrosclerosis.

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Section: Methodsmentioning

confidence: 99%

Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis

Zeller

Müller

Frank

et al. 2003

Cathet Cardio Intervent

111

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“…Unilateral renal artery stenosis was classified as hemodynamically relevant if the difference in intrarenal resistance index according to Pourcelot between the 2 renal arteries was Ͼ0.05. 30 Before intervention, duplex ultrasound was always confirmed by angiography showing a percent diameter stenosis Ն70% on visual estimation. The visual estimate was checked by quantitative computerized angiography (QCA-CMS, Medis Medical Imaging Systems) (Table).…”

Section: Patient Selection and Renal Stent Placementmentioning

confidence: 99%

Predictors of Improved Renal Function After Percutaneous Stent-Supported Angioplasty of Severe Atherosclerotic Ostial Renal Artery Stenosis

et al. 2003

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Background-Percutaneous stent-supported angioplasty is a treatment option for atherosclerotic ostial renal artery stenosis. Improvement of renal function by such intervention, however, is controversial and thought to be limited to specific subsets, such as nondiabetic patients and bilateral stenoses. In this prospective study, we investigated predictors for improvement of renal function and blood pressure after renal artery stent placement. Methods and Results-The study included 215 consecutive patients with ostial renal artery stenosis of Ն70% diameter stenosis undergoing stent-supported angioplasty. The primary end point was decrease in serum creatinine concentration at 1 year; the secondary end point, decrease in average mean arterial blood pressure assessed by 24-hour monitoring.

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“…There is a highly specific correlation between a side difference of an RI of greater than or equal to 0.05 and an angiographic diameter stenosis of at least 70% in the presence of a unilateral RAS [14][15][16][17]. In case of bilateral RAS, the side difference of the RI is not predictive; in this situation an acceleration time of greater than 0.07 seconds is the most reliable duplex crite rion for an angiographic ally confirmed stenosis of at least 70% ( Fig.…”

Section: Imaging Techniques Angiographymentioning

confidence: 85%

“…All other duplex parameters, such as a peak systolic flow velocity greater than 200 cm/sec or the renal aortic flow velocity ratio greater than 3.5 [19,20] as used in most former studies to detect stenosis, are correlated to a 50% or 60% angiographic diameter stenosis and are therefore not specific for a hemodynamically relevant RAS and detect already mid-grade stenosis [15]. If duplex ultrasound can be performed by an experienced physician with an adequate ultrasound machine, this should be the preferred diagnostic and follow-up imaging method.…”

Section: Imaging Techniques Angiographymentioning

confidence: 98%

Renal artery stenosis

Zeller

2007

Curr Treat Options Cardio Med

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Fibromuscular dysplasia (FMD) and aortoarteritis are the most frequent causes of secondary hypertension induced by renal artery stenosis (RAS). Revascularization of this disease entity usually cures arterial hypertension. Demographic evolution leads to an increasing incidence of atherosclerotic RAS, one of the major causes of end-stage renal failure. Furthermore, atherosclerotic RAS leads to deterioration of primary hypertension, progression of atherosclerosis manifestation such as occlusive and aneurysmatic peripheral artery disease, and chronic or acute organ damage such as left ventricular hypertrophy and recurrent flash pulmonary edema. Despite the lack of sufficiently powered randomized controlled trials, each hemodynamically relevant RAS (eg, > or = 70%) should be considered for stent angioplasty in patients without end-stage ischemic nephropathy or limited life expectancy due to concomitant disease (eg, cancer). Drug-eluting stents will probably reduce the overall low in-stent restenosis rate of 10% to 20%. Interventions in patients with dialysis-dependent end-stage nephropathy are left to appropriate clinical study protocols.

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Farbduplexsonographische Darstellbarkeit von Nierenarterien und Erkennung hämodynamisch relevanter Nierenarterienstenosen

Cited by 42 publications

References 19 publications

Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis

Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis

Predictors of Improved Renal Function After Percutaneous Stent-Supported Angioplasty of Severe Atherosclerotic Ostial Renal Artery Stenosis

Renal artery stenosis

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