Recurrent Pulmonary Oedema in Hypertension Due to Bilateral Renal Artery Stenosis: Treatment by Angioplasty or Surgical Revascularisation

Pickering, T.G.; Devereux, R B; James, GaryD.; Silane, Michael; Herman, Lawrence L.; Sotelo, JulioE.; Ta, Sos; Jh, Laragh

doi:10.1016/s0140-6736(88)92668-2

Cited by 266 publications

(130 citation statements)

References 10 publications

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“…32 Furthermore, the first manifestation of renal artery stenosis is cardiac dysfunction: flash pulmonary edema, congestive heart failure, or unstable angina. 7,8 Renovascular disease is a significant cause of renal failure, with its presence having the worst effect on prognosis. 5 Mailloux et al, 6 detailing 683 patients on hemodialysis, demonstrated that patients with renal artery stenosis as the cause of the end-stage renal disease had the poorest survival (5-and 10-year survivals of 18% and 5%, respectively) among all causes of end-stage renal disease other than diabetic glomerulosclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Although surgical revascularization has cured or improved blood pressure control, preserved or stabilized renal function, 9 -15 and reversed end-stage renal failure, 16 -18 its morbidity and mortality rates have been higher than those of stent revascularization. 19 -24 Stent revascularization has created the perception of superiority to balloon angioplasty [25][26][27][28][29][30][31] and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data.…”

mentioning

confidence: 99%

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Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

et al. 1998

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Background-Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. Methods and Results-Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for Ն6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166Ϯ26 to 148Ϯ22 mm Hg and from 86Ϯ14 to 80Ϯ11 mm Hg, respectively; PϽ0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74Ϯ4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92Ϯ4%) baseline renal function, fair (74Ϯ7%) in those with mildly impaired renal function, and poor (52Ϯ7%) in patients with elevated baseline creatinine levels (Ն2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. Conclusions-Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival. (Circulation. 1998;98:642-647.)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

et al. 1998

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“…It is also an important reversible cause of recurrent pulmonary oedema and apparent congestive heart failure in patients without overt coronary or valvular heart disease. [1][2][3] Our case clearly demonstrates that atheromatous vascular disease should be regarded as a generalised process not confined to one vascular tree. Patients routinely referred and assessed for lower limb vascular disease are particularly at high risk of having renal artery disease.…”

mentioning

confidence: 71%

Digital aortography showing extensive aneurysmal aortoiliac disease and severe proximal renal artery stenosis in a patient with a history of acute myocardial infarction

Missouris

Buckenham

et al. 1999

J Hum Hypertens

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“…'Flash' pulmonary oedema may occur in patients with severe bilateral ARAS despite normal left ventricular function and is cured by adequate revascularisation. 32 A recent report of improved angina and heart failure status in patients undergoing renal artery stenting for ARAS is intriguing. 33 Morbidity related to the stenosis in patients with atheromatous renovascular disease has probably been overestimated.…”

Section: Does Revascularisation Beneficially Affect Hypertension or Rmentioning

confidence: 99%

Atherosclerotic renal artery stenosis: is it worth diagnosing?

Eardley

Lipkin

1999

J Hum Hypertens

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Atherosclerotic renal artery stenosis (ARAS) is the commonest cause of secondary hypertension and is the cause of end stage renal failure in up to 20% of patients starting dialysis. Associated with it is a high morbidity and appalling mortality. The aetiology of ischaemic nephropathy is complex and is not simply related to renal artery narrowing. Captopril renography is sensitive and specific for diagnosing ARAS in patients with normal renal function. In those with renal impairment gadolinium-enhanced MRA or spiral CT angiography clearly define renal anatomy. Over 80% of ARAS is

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Recurrent Pulmonary Oedema in Hypertension Due to Bilateral Renal Artery Stenosis: Treatment by Angioplasty or Surgical Revascularisation

Cited by 266 publications

References 10 publications

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

Digital aortography showing extensive aneurysmal aortoiliac disease and severe proximal renal artery stenosis in a patient with a history of acute myocardial infarction

Atherosclerotic renal artery stenosis: is it worth diagnosing?

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