Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study.

Background The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high-risk clinical presentations as defined in a national protocol developed in 2015. Methods and Results Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high-risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24-hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0-170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8-7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m2 (95% CI, 36.6-45.6). In 96 patients with available 3-month follow-up data, mean 24-hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4-23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%-62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/min per 1.73m2 (95% CI, 4.5-11.1; P<0.001). All changes persisted after 24 month follow-up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. Conclusions In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting. Registration URL: https://clinicaltrials.gov. Identifier: NCT02770066.

[Trauma of the popliteal artery. Twenty three patients treated during a 27-year-period]. / Laesion af arteria poplitea. Treogtyve patienter behandlet over en 27-års-periode.

INTRODUCTION: Trauma of the popliteal artery is a rare event. During a period of 14 years, only 59 cases were registered in Denmark in the national register Karbase. There are several pitfalls in the management of popliteal artery lesions which may lead to an increased risk of amputation. This article analyses our own results and discusses selected topics concerning the management of popliteal artery injuries. MATERIALS AND METHODS: The records of 23 patients treated for injury of the popliteal artery over a 27-year period were reviewed. A follow-up investigation was performed. The patients' Doppler pressure was measured. RESULTS: There were three (13%) amputations. At the time of follow-up, 5 of the patients were dead; 1 person was living abroad. Of the remaining 17 patients, 15 had no vascular symptoms; 2 patients had been amputated initially, and 1 patient had been treated conservatively. DISCUSSION: Management of a popliteal artery injury can be difficult and requires an experienced approach. Our results reveal excellent long-term patency of the vascular reconstruction with the saphenus vein. Furthermore, amputation is almost always due to major soft tissue injury or delayed surgical intervention. The amputation rate of 13% in this material is in line with that in the literature. We recommend that every patient suffering from major trauma of an extremity have a Doppler pressure measurement performed and registered during the initial evaluation in the casualty department.