Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

Alhadad, Alaa; Mattiasson, Ingrid; Ivancev, Krassi; Gottsäter, Anders; Lindblad, Bengt

doi:10.1038/sj.jhh.1001893

Cited by 65 publications

(40 citation statements)

References 36 publications

(32 reference statements)

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“…The writing group determined that new data support the equivalency of surgical and endovascular treatment, with lower morbidity and mortality associated with endovascular treatment but higher patency rates with surgical treatment in those patients who survived for at least 2 years after randomization. 5 The writing group also notes that new data suggest that 1) the efficacy of revascularization may be reduced in patients with branch artery stenoses 7 and 2) patients undergoing renal artery bypass may do best when surgery is performed in high-volume centers. 8 11 On the basis of this large epidemiologic study, the 2011 writing group modified the age for consideration of ABI diagnostic testing to Ն65 years.…”

Section: Scope Of the Focused Updatementioning

confidence: 99%

2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)

Hirsch²,

et al. 2011

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Section: Scope Of the Focused Updatementioning

confidence: 99%

2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)

Hirsch²,

et al. 2011

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“…Percutaneous balloon angioplasty has become the preferred method of revascularization with a low complication rate and good results (4,5). Stents are typically used only as a bailout (i.e., if there is dissection or disruption of the renal artery), but are not typically necessary to achieve a hemodynamically satisfactory result.…”

Section: Discussionmentioning

confidence: 99%

Fibromuscular Dysplasia of the Renal Artery as a Cause of Secondary Hypertension

Hundae¹,

Hebert²,

Schussler³

2013

Baylor University Medical Center Proceedings

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Fibromuscular dysplasia is an uncommon cause of secondary hypertension. When the resulting hypertension cannot be successfully treated with medications, balloon angioplasty has been shown to be successful by disrupting the "webs" of tissue in the renal artery. We present a case of secondary hypertension due to fibromuscular dysplasia and the successful treatment with balloon angioplasty. CASE DESCRIPTIONA 61-year-old woman was referred to Baylor University Medical Center at Dallas for severe hypertension, uncontrolled on several medications. Approximately 1 year earlier, she had been evaluated for "food poisoning" and headache. At that time she was found to have a systolic blood pressure of 180 mm Hg. She subsequently developed a left parietal bleed. She was treated with carvedilol and hydrochlorothiazide, but because of her age, the sudden onset, and the severity of the hypertension, secondary causes were suspected. A meta-iodobenzylguanidine test was performed. It was believed to be positive, and a left adrenalectomy was performed. Despite medical therapy and the adrenal gland resection, she continued to have severe hypertension, with blood pressures in excess of 180 mm Hg systolic at home. A magnetic resonance angiogram (MRA) of her renal arteries showed "beads on a string" in her right renal artery. As this was suggestive of fi bromuscular dysplasia (FMD), she was referred for invasive renal artery angiography. Th e angiogram demonstrated FMD and balloon angioplasty was successfully performed (Figure). On follow-up clinic visits, her blood pressure had normalized on only a low dose of angiotensinconverting enzyme inhibitor. DISCUSSIONFMD is a disease of unknown etiology that results in "webs" of tissue which perturb the flow of blood through arterial vasculature. It commonly involves the renal and carotid arteries, although it can involve vertebral, iliac, subclavian, and visceral arteries. Disease manifestation may vary widely depending on the arterial segment involved and its severity (1). In adults, women account for about 90% of the cases. Renal FMD accounts for about 70% of this disease process. In adults it accounts for about 10% of renovascular hypertension. FMD of the renal arteries is bilateral in about 40% of patients (2). Clinical manifestations are usually a consequence of decreased fl ow across the renal webs.Severe resistant hypertension, a sudden rise in blood pressure, and increased serum creatinine upon initiation of angiotensin-converting enzyme inhibitors are common presentations of FMD and should be included in the diff erential diagnosis when young women present with accelerated hypertension, especially if there is intolerance to antihypertensive medication. Abdominal bruits can sometimes be heard.Angiography is the gold standard for the diagnosis of FMD, but the diagnosis can be made by noninvasive tests (3). Computed tomographic angiography is good at detecting FMD. Duplex ultrasound is highly operator and center dependent, but can suggest the diagnosis. MRA has a sensitivity of about ...

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“…The following conditions are currently considered valid indications for investigating with MRI/MRA for renovascular disease: (i) Hypertensive patients without renal dysfunction, especially those with high pretest probability of disease such as those with hypertension at a young age, and those in whom fibromuscular dysplasia could be the underlying disease (20)(21)(22) , both of which enshrine the ALARA principle (As Low As Reasonably Achievable) such that the use of an imaging test without ionizing radiation exposure is preferable to one that does when diagnostic yield is equivalent. Furthermore, CTA has not been as well validated as has CE-MRA in the trials available to date, and there are difficulties in assessing degrees of stenosis with CTA where there is heavily calcified plaque, a particular problem in patients with chronic renal insufficiency.…”

Section: Current Position: Indications For Imaging and Imaging Technimentioning

confidence: 99%

Renovascular imaging in the NSF Era

Roditi

Maki

Oliveira

et al. 2009

Magnetic Resonance Imaging

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The detection of the association between nephrogenic systemic fibrosis (NSF), a rare but potentially life‐threatening disease only encountered in patients with severely impaired renal function, and the previous administration of some Gd‐chelates has cast a shadow on the administration of Gd‐chelates in patients with chronic renal failure. So far, contrast‐enhanced MR‐angiography (MRA) was considered the best diagnostic modality in patients with suspected renal disease. This review explores the most appropriate use of renal MRA with a focus on newly developed nonenhanced MRA techniques. Nonenhanced MRA techniques mainly based on SSFP with ECG‐gating allow for acceptable spatial resolution to visualize at least the proximal parts of the renal arteries. In addition functional renal imaging techniques and their current clinical role are critically appreciated. J. Magn. Reson. Imaging 2009;30:1323–1334. © 2009 Wiley‐Liss, Inc.

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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

Cited by 65 publications

References 36 publications

2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)

2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)

Fibromuscular Dysplasia of the Renal Artery as a Cause of Secondary Hypertension

Renovascular imaging in the NSF Era

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