Outcomes of Hypertensive Patients with Renal Fibromuscular Dysplasia Compared with Patients with Concomitant Atherosclerotic Renal Artery Stenosis following Endovascular Therapy

Jenkins, Thomas L.; Baker, Mary Grace; Baheti, Aparna; Sharma, Aditya; Patrie, James T.; Angle, John F.; Matsumoto, Alan H.

doi:10.1016/j.jvir.2015.01.027

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…From the literature it is known that the results of surgical treatment are favorable, with an early postoperative occlusion or restenosis rate after elective procedure reported in 3.8–13% of cases (more often with venous grafts than with arterial autografts). 27–29 Our findings support the current consensus recommending restriction of renal artery stenting in the management of acute periprocedural complications of renal angioplasty. 2…”

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

“…For example, Jenkins et al reported that more than one angioplasty procedure was required in 15 of 42 (32.6%) patients with FMD-RAS. 22 The largest meta-analysis of 36 studies including 1916 procedures showed an increasing restenosis rate during the follow-up period, from 13.2% at 1 year to 29.1% at 5 years. 23 It should also be emphasized that, in this study, stenting for restenosis after PTRA was not associated with a lower rate of recurrent restenosis as compared to repeat PTRA without stenting.…”

Section: Discussionmentioning

confidence: 99%

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Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study

Kądziela,

Jóźwik-Plebanek,

Pappaccogli

et al. 2023

Vasc Med

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Introduction: Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the study was to retrospectively analyze the immediate and long-term results of renal stenting versus angioplasty in patients with FMD. Methods: Of 343 patients in the ARCADIA-POL registry, 58 patients underwent percutaneous treatment due to FMD-RAS (in 70 arteries). Percutaneous transluminal renal angioplasty (PTRA) was performed as an initial treatment in 61 arteries (PTRA-group), whereas primary stenting was undertaken in nine arteries (stent-group). Stent-related complications were defined as: in-stent restenosis > 50% (ISR); stent fracture; under-expansion; or migration. Results: In the PTRA-group, the initial restenosis rate was 50.8%. A second procedure was then performed in 22 arteries: re-PTRA (12 arteries) or stenting (10 arteries). The incidence of recurrent restenosis after re-PTRA was 41.7%. Complications occurred in seven of 10 (70%) arteries secondarily treated by stenting: two with under-expansion and five with ISR. In the stent-group, stent under-expansion occurred in one case (11.1%) and ISR in three of nine stents (33.3%). In combined analysis of stented arteries, either primarily or secondarily, stent-related complications occurred in 11/19 stenting procedures (57.9%): three due to under-expansion and eight due to ISRs. Finally, despite several revascularization attempts, four of 19 (21%) stented arteries were totally occluded and one was significantly stenosed at follow-up imaging. Conclusion: Our study indicates that renal stenting in FMD-RAS may carry a high risk of late complications, including stent occlusion. Further observational data from large-scale registries are required.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study

Kądziela,

Jóźwik-Plebanek,

Pappaccogli

et al. 2023

Vasc Med

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“…Clear pathophysiology is yet uncertain, but their development is reported to be related to atherosclerosis and fibromuscular dysplasia in 60% of the cases, and to renal arterial hypertension in 25% of the cases [15,16].…”

Section: Discussionmentioning

confidence: 99%

A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

et al. 2022

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Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission in the surgical emergency room. The CT scan promptly demonstrated rupture of large retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient had the urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. The fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the following hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case in which hypovolemic shock manifested before the admission. We would like to highlight the importance of high blood-pressure control and the importance of regular check-ups.

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Arterielle Verschlusskrankheit der Nierenarterien

Zeller¹

2021

Klinische Angiologie

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Outcomes of Hypertensive Patients with Renal Fibromuscular Dysplasia Compared with Patients with Concomitant Atherosclerotic Renal Artery Stenosis following Endovascular Therapy

Cited by 6 publications

References 26 publications

Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study

Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study

A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Arterielle Verschlusskrankheit der Nierenarterien

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