Outcomes of endovascular treatment of renal arterial stenosis in transplanted kidneys

ABSTRACT Objective To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA. Materials and Methods We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered. Results Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identified with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases. On doppler evaluation, mean blood flow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a significant difference between between pre-intervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a significant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was 100%. Conclusions Endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS, ensuring the functionality of the graft and normalization of blood pressure and renal function.

Diagnosis and management of systemic hypertension due to renovascular and aortic stenosis in patients with Williams-Beuren syndrome

SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Doppler echocardiography showed cardiac abnormalities in 16/21 (76%) hypertensive patients. CONCLUSION Cardiac abnormalities and hypertension in patients with Williams-Beuren syndrome are common. Thus, thorough evaluation and follow-up are necessary to reduce cardiovascular risks and mortality of these patients

RESUMO OBJETIVO Descrever a incidência, o diagnóstico e o tratamento da hipertensão arterial sistêmica relacionada com estenose da artéria renal em pacientes com síndrome de Williams-Beuren. MÉTODOS Sessenta e cinco pacientes com síndrome de Williams-Beuren foram avaliados quanto à presença de hipertensão. Os pacientes foram submetidos à ultrassonografia com Doppler das artérias renais e ecocardiograma Doppler. Aqueles com suspeita de hipertensão renovascular foram submetidos à tomografia computadorizada ou angiografia por ressonância magnética da aorta e vasos renais ou angiografia convencional. RESULTADOS A hipertensão arterial sistêmica foi diagnosticada em 21/65 pacientes com síndrome de Williams-Beuren (32%, 13 do sexo masculino), com idade média de 13,9 anos (5 meses-20 anos). Em 8/21 pacientes foi detectada a hipertensão renovascular. Angioplastia não teve sucesso em cinco pacientes com estenose da artéria renal, necessitando de tratamento adicional. O ecocardiograma Doppler mostrou anormalidades cardíacas em 16/21 (76%) pacientes hipertensos. CONCLUSÃO As anormalidades cardíacas e hipertensão arterial em pacientes com síndrome de Williams-Beuren são muito frequentes, sendo necessários uma avaliação minuciosa e seguimento para diminuir o risco cardiovascular e a morbimortalidade desses pacientes

Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.

Angioplastía con stent en la estenosis de la arteria renal: nuestra experiencia / Angioplasty with stent in renal artery stenosis: our experience

Abstract. The aim of this study is to demonstrate the outcomes and efficacy of percutaneous treatment in patients with refractory or poorly controlled hypertension and renal insufficiency secondary to renal artery stenosis. Retrospective study including 16 patients treated by angioplasty and stent implantation. Blood pressure and renal function were evaluated in the first 24 hours, and at 6 months and 12 months follow-up. The mean systolic blood pressure decreased from 170 mm Hg to 145 mm Hg in the first 24 hrs, and to 138 mm Hg after 12 months of follow-up, with the diastolic pressure decreasing from 95 mm Hg to 77 mm Hg in the first 24 hrs and to 70 mm Hg after 12 months of follow-up. The renal function, according to the creatinine values remained stable.

En este estudio proporcionaremos los resultados y la eficacia de la angioplastia con stent en pacientes con estenosis de la arteria renal que presentaron secundariamente una hipertensión arterial mal controlada o refractaria e insuficiencia renal. Estudio retrospectivo donde se incluyeron a 16 pacientes tratados mediante angioplastia con stent, con seguimiento en las primeras 24 h, 6 meses y 12 meses postangioplastia, para vigilancia de las cifras tensionales y de la función renal, logrando reducir la tensión arterial sistólica de 170 mm Hg a 145 mm Hg en las primeras 24 h y a 138 mm Hg en el control de los 12 meses; la presión arterial diastólica pasó de 95 mm Hg a 77 mm Hg en las primeras 24 h, y 70 mm Hg en el control a los 12 meses. En cuanto a la función renal hubo estabilidad.

Hypertension due to angiodysplasia.

Renovascular hypertension is non essential hypertension, wherein anatomically evident arterial occlusive disease and increased blood pressures are related as cause and effect. The hypertension is due to renal ischemia. Angiodysplasia is an uncommon angiopathy associated with heterogeneous histological changes that may affect the carotid circulation and the visceral and peripheral arteries.

Posterior reversible encephalopathy syndrome revealing Takayasu's arteritis.

Posterior reversible encephalopathy syndrome is a rare neuroradiologic condition associated with headache, seizures, altered sensorium, visual disturbances, and characteristic lesions on neuroimaging predominantly affecting the posterior regions of the brain. We report a 10-years-8-months-old girl who presented with headache, multiple seizures, and altered sensorium. Her blood pressure was 130/100 mmHg and left brachial pulse was not palpable. CT scan brain showed typical non-enhancing hypodensities in bilateral parieto-occiptal lobes. Prompt treatment of the hypertension led to rapid reversal of neurological symptoms. CT aortogram revealed aortoarteritis with bilateral renal artery stenosis.

Recanalization of a single functioning kidney.

For patients with renal artery stenosis, percutaneous transluminal angioplasty is generally the treatment of choice. This report describes the case of an elderly lady with type III aortoarteritis whose right renal artery was successfully recalized and stented. There was satisfactory improvement in renal function and blood pressure post-procedure, and at one-month follow-up.

Concurrent coronary, bilateral iliac and left renal artery direct stenting.

We describe a patient who underwent percutaneous coronary intervention combined with bilateral iliac and left renal artery angioplasty during the same sitting. Stenting of the coronary and peripheral arteries was performed employing the "direct stenting" technique. No complications occurred. The patient was discharged 2 days after the intervention and remains asymptomatic, leading a fully active life during 1 year of follow-up. To our knowledge, unstaged coronary stenting combined with direct stenting of the renal and both common iliac arteries has not been reported previously in India.

Detection of Segmental Branch Renal Artery Stenosis by Doppler US: A Case Report

In stenosis of a segmental branch or among multiple renal arteries, Doppler sampling of intrarenal arteries in the upper, mid and lower poles demonstrates strikingly different waveform patterns that might otherwise be overlooked. We report a case of segmental branch renal artery stenosis in which a pulsus parvus et tardus waveform was observed in a segmental branch of a renal artery. In this case, systematic analysis of Doppler waveforms of intrarenal arteries at more than three different locations facilitated a rapid and confident diagnosis of seg-mental branch renal artery stenosis.

Scintigraphic evaluation of renovascular hypertension

ACE inhibitor challenged renal scintigraphic studies offer noninvasive means of evaluating patients for renovascular hypertension, and provide help in selecting patients who will benefit most from interventional procedures designed for alleviation of renal artery stenosis. These studies provide functional assessment of each kidney which also helps the vascular surgeons to plan which renal artery to repair first, when bilateral renal arteries are stenotic, prior to an abdominal aortic aneurysm repair. Vasotec challenged Tc99mMAG3 renal scintigraphy is one of such tests with several advantages over other similar methods, and appears to have a great potential of being a preferred scintigraphic study for evaluation of renovascular hypertension.