Atherosclerotic renal artery stenosis--diagnosis and treatment.
Summary of "Atherosclerotic renal artery stenosis--diagnosis and treatment."
Renal artery stenosis (RAS) is characterized by a heterogeneous group of pathophysiologic entities, of which fibromuscular dysplasia and atherosclerotic RAS (ARAS) are the most common. Whether and which patients should undergo revascularization for ARAS is controversial. The general consensus is that all patients with ARAS should receive intensive medical treatment. The latest randomized clinical trials have increased confusion regarding recommendations for revascularization for ARAS. Although revascularization is not indicated in all patients with ARAS, experts agree that it should be considered in some patients, especially those with unstable angina, unexplained pulmonary edema, and hemodynamically significant ARAS with either worsening renal function or with difficult to control hypertension. A search of the literature was performed using PubMed and entering the search terms renal artery stenosis, atherosclerotic renal artery stenosis, and renal artery stenosis AND hypertension to retrieve the most recent publications on diagnosis and treatment of ARAS. In this review, we analyze the pathways related to hypertension in ARAS, the optimal invasive and noninvasive modalities for evaluating the renal arteries, and the available therapies for ARAS and assess future tools and algorithms that may prove useful in evaluating patients for renal revascularization therapy.
Affiliation
University of California San Francisco, Division of Cardiology, 505 Parnassus Ave, Box 0103, San Francisco, CA 94143-0103. yeghiaza@medicine.ucsf.edu.
Journal Details
This article was published in the following journal.
Name: Mayo Clinic proceedings. Mayo Clinic
ISSN: 1942-5546
Pages: 649-57
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21719621
- DOI: http://dx.doi.org/10.4065/mcp.2011.0181
Medical and Biotech [MESH] Definitions
Angioplasty, Balloon
Use of a balloon catheter for dilatation of an occluded artery. It is used in treatment of arterial occlusive diseases, including renal artery stenosis and arterial occlusions in the leg. For the specific technique of balloon dilatation in coronary arteries, ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY is available.
Coronary Artery Disease
Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause.
Renal Artery Obstruction
Narrowing or occlusion of the RENAL ARTERY or arteries. It is due usually to ATHEROSCLEROSIS; FIBROMUSCULAR DYSPLASIA; THROMBOSIS; EMBOLISM, or external pressure. The reduced renal perfusion can lead to renovascular hypertension (HYPERTENSION, RENOVASCULAR).
Carotid Stenosis
Narrowing or stricture of any part of the CAROTID ARTERIES, most often due to atherosclerotic plaque formation. Ulcerations may form in atherosclerotic plaques and induce THROMBUS formation. Platelet or cholesterol emboli may arise from stenotic carotid lesions and induce a TRANSIENT ISCHEMIC ATTACK; CEREBROVASCULAR ACCIDENT; or temporary blindness (AMAUROSIS FUGAX). (From Adams et al., Principles of Neurology, 6th ed, pp822-3)
Coronary-subclavian Steal Syndrome
A complication of INTERNAL MAMMARY-CORONARY ARTERY ANASTOMOSIS whereby an occlusion or stenosis of the proximal SUBCLAVIAN ARTERY causes a reversal of the blood flow away from the CORONARY CIRCULATION, through the grafted INTERNAL MAMMARY ARTERY (internal thoracic artery), and back to the distal subclavian distribution.
PubMed Articles
Atherosclerotic Renal Artery Stenosis: An Update on Diagnosis and Management.
Atherosclerotic renal artery stenosis (ARAS) is a progressive disease and it is usually associated with hypertension as well as with chronic kidney and cardiovascular disease. Although the anatomical...
Atherosclerotic Renal Artery Stenosis: An Update on Diagnosis and Management.
Atherosclerotic renal artery stenosis (ARAS) is a progressive disease and it is usually associated with hypertension as well as with chronic kidney and cardiovascular disease. Although the anatomical...
Diagnosis and therapy of atheromatous renal artery stenosis.
Atheromatous renal artery stenosis (ARAS), a lesion of systemic atherosclerotic disease, is the leading cause of stenotic lesions in the renal artery, followed by fibromuscular dysplasia, a primary ab...
Ankle brachial index is a valuable index of the severity of atherosclerotic renal artery stenosis.
Abstract Objective. The objective of this study was to investigate the relationship between the ankle brachial index (ABI) and the severity of atherosclerotic renal artery stenosis (ARAS). Material...
Atherosclerotic renal artery stenosis is a frequent cause of arterial hypertension and/or allograft dysfunction after kidney transplantation and is usually located at the iliac artery anastomosis. Fib...
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