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Short- and mid-term results of balloon angioplasty for renal artery fibromuscular dysplasia. Cardiovasc Interv Ther 2014; 29:293-9. [DOI: 10.1007/s12928-014-0253-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
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102
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Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048-78. [PMID: 24548843 DOI: 10.1161/01.cir.0000442577.96802.8c] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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103
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Successful percutaneous transluminal angioplasty for the treatment of renovascular hypertension with an atrophic kidney. Heart Vessels 2014; 30:274-9. [PMID: 24384893 PMCID: PMC4352654 DOI: 10.1007/s00380-013-0457-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/13/2013] [Indexed: 11/17/2022]
Abstract
Renovascular hypertension is an important cause of secondary hypertension. We present the case of a 61-year-old man with renovascular hypertension caused by chronic total occlusion of the left renal artery resulting in an atrophic kidney. Although renography indicated almost no residual function of the left kidney, renal vein sampling showed a significant increase of renin secretion in the left kidney. The endocrine function of the left kidney was believed to be preserved; thus, we performed percutaneous transluminal renal angioplasty with stent placement. After the procedure, the patient’s blood pressure decreased gradually to within the normal range without adverse events. The laboratory data on endocrine function and the renography findings drastically improved. Percutaneous transluminal renal angioplasty is a promising therapeutic procedure for renovascular hypertension with an atrophic kidney.
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Mori T, Watanabe K, Matsushita H, Fujimaki A, Kimura C, Yoshida A, Wakatsuki A. Intravenous nicardipine for the treatment of renovascular hypertension due to fibromuscular dysplasia during pregnancy: A case study. HYPERTENSION RESEARCH IN PREGNANCY 2014. [DOI: 10.14390/jsshp.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toshitaka Mori
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
| | - Kazushi Watanabe
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
| | - Hiroshi Matsushita
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
| | - Ai Fujimaki
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
| | - Chiharu Kimura
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
| | - Atsumi Yoshida
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
| | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine
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105
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106
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Ayach T, Kazory A. Bilateral renal infarction: an uncommon presentation of fibromuscular dysplasia. Clin Kidney J 2013; 6:646-9. [PMID: 26069835 PMCID: PMC4438380 DOI: 10.1093/ckj/sft133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/30/2013] [Indexed: 11/12/2022] Open
Abstract
While fibromuscular dysplasia (FMD) is an established cause of secondary hypertension, its association with renal infarction is less well recognized. We report a middle-aged man who presented with complaints of loin pain and severe hypertension. Computed tomography angiography of the abdomen revealed bilateral renal infarction with multiple short-segment arterial dissection compatible with FMD in the absence of systemic vasculitis and other risk factors for thromboembolic events. Bilateral renal infarction complicating FMD is extremely rare and has so far been reported only in a handful of cases. Physicians encountering cases of otherwise unexplained renal infarction/ischemia need to be aware of this complication.
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Affiliation(s)
- Taha Ayach
- Division of Nephrology, Hypertension, and Renal Transplantation , University of Florida , Gainesville, FL , USA
| | - Amir Kazory
- Division of Nephrology, Hypertension, and Renal Transplantation , University of Florida , Gainesville, FL , USA
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107
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Uema A, Araki M, Sonoda S, Shimizu A, Kashiyama K, Muraoka Y, Suzuki Y, Kamezaki F, Tsuda Y, Takeuchi M, Okazaki M, Otsuji Y. Successful coronary intervention for spontaneous coronary dissection in a patient with fibromuscular dysplasia. J Cardiol Cases 2013; 8:158-160. [PMID: 30534281 PMCID: PMC6277597 DOI: 10.1016/j.jccase.2013.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/03/2013] [Accepted: 07/25/2013] [Indexed: 11/30/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a reported rare cause of acute coronary syndrome (ACS) and sudden death among middle-aged women. Some institutes have recently reported fibromuscular dysplasia (FMD) concomitant with SCAD. Therefore, a survey of the presence of comorbid FMD in SCAD patients is important to obtain a definitive diagnosis and for the prediction of possible SCAD recurrence. The optimal treatment of ACS due to SCAD remains undetermined, and technical failures are frequently encountered in primary percutaneous coronary intervention (PCI) owing to the unusual non-atherosclerotic cause of the disease. We report a case of SCAD successfully treated with cutting balloon PCI under intravascular ultrasound guidance without stent implantation, in which FMD was detected in the right external iliac artery through screening by noncoronary angiography, not duplex ultrasound. .
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Affiliation(s)
| | - Masaru Araki
- Department of Cardiology and Renal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8556, Japan
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108
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109
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Fibromuscular dysplasia of the renal artery: An underdiagnosed cause of severe hypertension. Int J Cardiol 2013; 167:e159-60. [DOI: 10.1016/j.ijcard.2013.04.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 04/20/2013] [Indexed: 11/19/2022]
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110
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An X, Jiang X, Dong H, Peng M, Zou Y, Song L, Guan T, Zhou X, Yang Y. Fibromuscular dysplasia affecting a two-branched renal artery in a patient with a solitary kidney: case presentation. Clin Cardiol 2013; 36:E7-10. [PMID: 23780717 DOI: 10.1002/clc.22149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 04/26/2013] [Indexed: 01/09/2023] Open
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory arterial disease, commonly involving the renal arteries. Here we report a case of a 16-year-old Chinese male who was found to have severe hypertension with proteinuria for 2 years. Computed tomography showed absence of the left kidney and enlargement of the right kidney. Subsequent angiography confirmed the above findings and revealed narrowing of both the upper and lower branches of the right renal artery caused by FMD. These combined lesions are very rare, and individuals affected are at increased risk of renal dysfunction if left untreated. Treatment with percutaneous balloon angioplasty is the first choice in such a patient and usually results in optimal outcomes.
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Affiliation(s)
- Xuanqi An
- Hypertension Center, Department of Cardiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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111
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Sekar N, Shankar R. Fibromuscular dysplasia with multiple visceral artery involvement. J Vasc Surg 2013; 57:1401. [PMID: 23601593 DOI: 10.1016/j.jvs.2011.12.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 12/27/2011] [Accepted: 12/27/2011] [Indexed: 10/26/2022]
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112
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Savard S, Azarine A, Jeunemaitre X, Azizi M, Plouin PF, Steichen O. Association of Smoking With Phenotype at Diagnosis and Vascular Interventions in Patients With Renal Artery Fibromuscular Dysplasia. Hypertension 2013; 61:1227-32. [DOI: 10.1161/hypertensionaha.111.00838] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sébastien Savard
- From the Hypertension Unit (S.S., M.A., P.-F.P.), Department of Vascular Radiology (A.A.), Department of Genetics and Reference Centre for Rare Vascular Diseases (X.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France (X.J., M.A., P.-F.P.); INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France (X.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Internal
| | - Arshid Azarine
- From the Hypertension Unit (S.S., M.A., P.-F.P.), Department of Vascular Radiology (A.A.), Department of Genetics and Reference Centre for Rare Vascular Diseases (X.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France (X.J., M.A., P.-F.P.); INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France (X.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Internal
| | - Xavier Jeunemaitre
- From the Hypertension Unit (S.S., M.A., P.-F.P.), Department of Vascular Radiology (A.A.), Department of Genetics and Reference Centre for Rare Vascular Diseases (X.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France (X.J., M.A., P.-F.P.); INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France (X.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Internal
| | - Michel Azizi
- From the Hypertension Unit (S.S., M.A., P.-F.P.), Department of Vascular Radiology (A.A.), Department of Genetics and Reference Centre for Rare Vascular Diseases (X.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France (X.J., M.A., P.-F.P.); INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France (X.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Internal
| | - Pierre-François Plouin
- From the Hypertension Unit (S.S., M.A., P.-F.P.), Department of Vascular Radiology (A.A.), Department of Genetics and Reference Centre for Rare Vascular Diseases (X.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France (X.J., M.A., P.-F.P.); INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France (X.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Internal
| | - Olivier Steichen
- From the Hypertension Unit (S.S., M.A., P.-F.P.), Department of Vascular Radiology (A.A.), Department of Genetics and Reference Centre for Rare Vascular Diseases (X.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France (X.J., M.A., P.-F.P.); INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France (X.J.); Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Department of Internal
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113
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Gallagher KA, Tracci MC, Scovell SD. Vascular arteritides in women. J Vasc Surg 2013; 57:27S-36S. [PMID: 23522715 DOI: 10.1016/j.jvs.2012.10.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 08/03/2012] [Accepted: 10/26/2012] [Indexed: 12/22/2022]
Abstract
The vasculitides are multiple clinical disease states that are characterized by inflammation of the wall of blood vessels. They are typically classified by the size of the vessel that is affected. Some of the vasculitides are more commonly identified in women, such as the large-vessel vasculitides. In addition, the incidence of some of the medium and small-vessel vasculitides in women has increased during the past several decades. These inflammatory conditions specifically affecting women will be reviewed here. The implications that pregnancy may have on various vasculitides will also be highlighted.
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Affiliation(s)
- Katherine A Gallagher
- Division of Vascular and Endovascular Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
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114
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Stark MM, Skeik N, Delgado Almandoz JE, Crandall BM, Tubman DE. Concurrent Basilar Artery Double Fenestration With Aneurysm and Vertebral Artery Dissection: Case Report and Literature Review of Rare Cerebrovascular Abnormalities. Ann Vasc Surg 2013; 27:497.e15-21. [DOI: 10.1016/j.avsg.2012.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 05/31/2012] [Accepted: 06/05/2012] [Indexed: 11/30/2022]
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115
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Abstract
Unruptured intracranial aneurysms (UIA) are a common finding, occurring in about 2% of the population, making them very likely to be seen by most practitioners, and present a challenge in the recommendations for optimal management and screening. The consequences of aneurysm rupture are dire, with high likelihood of significant morbidity and mortality. Most aneurysms do not rupture and patients harboring these lesions often remain asymptomatic. There are effective surgical and endovascular interventions to prevent rupture, but these procedures carry a risk of adverse complications. This article addresses the challenges of screening and management of UIAs.
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116
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Tullus K. Renovascular hypertension--is it fibromuscular dysplasia or Takayasu arteritis. Pediatr Nephrol 2013; 28:191-6. [PMID: 22453736 DOI: 10.1007/s00467-012-2151-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/02/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
Renovascular hypertension (RVH) can be caused by many different diseases, with the most common being fibromuscular dysplasia (FMD) and Takayasu arteritis (TA). A strikingly different diagnostic pattern is seen in children with RVH from different parts of the world. In Europe and North America, these children are mainly diagnosed as having FMD while in Asia and South Africa they will most often get a diagnosis of TA. When comparing the clinical diagnosis for FMD and TA, it becomes obvious that there is a great deal of overlap between the definitions of these two conditions. Different ways to come to the most accurate diagnosis using imaging of the blood vessel wall and positron emission tomography (PET) will be discussed. How an accurate diagnosis should influence the treatment of the children with these conditions will also be addressed.
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Affiliation(s)
- Kjell Tullus
- Great Ormond St Hospital - Paediatric Nephrology, Great Ormond Street, London, WC1N 3JH, UK.
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117
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Olin JW, Gornik HL. Standing waves are not fibromuscular dysplasia. JACC Cardiovasc Interv 2013; 5:888; author reply 888-9. [PMID: 22917464 DOI: 10.1016/j.jcin.2012.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 11/19/2022]
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118
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Tokushige SI, Maekawa R, Nose Y, Shiio Y. [A case of lateral medullary syndrome with neurogenic bladder]. Rinsho Shinkeigaku 2013; 52:79-83. [PMID: 22354230 DOI: 10.5692/clinicalneurol.52.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CASE REPORT A 45-year-old man came to our hospital with a chief complaint of occipital pain followed by gait disturbance and developing hypohidrosis on the right side 6 days after the onset. Brain MRI revealed an acute infarction in the dorsolateral part of right medulla. Bladder catheter was inserted because of dysuria. 8 days after the onset, the bladder contraction and desire to urinate were normal, by cystometry. However, micturition was still impossible without a catheter. His dysuria was considered to be due to Detrusor-Sphincter Dyssynergia (DSD). 19 days after the onset, he was able to urinate without a catheter. We found only 5 reported cases of lateral medullary infarction with dysuria, all of which had abnormal bladder contraction. This is the first case report of lateral medullary infarction with dysuria in spite of normal bladder contraction.
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119
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Saw J, Ricci D, Starovoytov A, Fox R, Buller CE. Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv 2013; 6:44-52. [PMID: 23266235 DOI: 10.1016/j.jcin.2012.08.017] [Citation(s) in RCA: 288] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 01/25/2023]
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120
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Abstract
Hypertension is the most common modifiable risk factor for cardiovascular disease. Antihypertensive treatment substantially reduces the risk of heart failure, stroke, and myocardial infarction. Current guidelines recommend screening all adults for high blood pressure (BP). Lifestyle modifications to help control high BP include weight loss, exercise, moderation of alcohol intake, and a diet low in sodium and saturated fats and high in fruits and vegetables. Out-of-office BP monitoring should be used to confirm suspected white coat effect, especially in patients with apparent resistant hypertension.
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Affiliation(s)
- Katherine H Winter
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599-7595, USA
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121
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Kok HK, Leong S, Govender P, Browne R, Torreggiani WC. Percutaneous renal artery angioplasty and stenting: indications, technique and results. Ir J Med Sci 2012. [PMID: 23207915 DOI: 10.1007/s11845-012-0887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Percutaneous interventions for renal arterial disease can be used to treat a variety of conditions including both atherosclerotic and non-atherosclerotic renal artery stenosis (RAS) as well as endovascular management of renal artery aneurysms (RAA). AIM We sought to examine the indications, techniques and results of percutaneous renal angioplasty and stenting in our institution over a 6-year period and review the current evidence for practice. METHODS Patient demographics, procedure indications, technical procedural details, complications, baseline and follow-up renal profile indices were analysed. RESULTS The most common indication for intervention was atherosclerotic RAS (69.2%) followed by RAS secondary to fibromuscular dysplasia (15.3%) and RAA (15.3%). There was a 100% technical success in our cohort of patients. The majority of patients (84.6%) had cross-sectional imaging in the form of computed tomography or magnetic resonance angiography prior to intervention. CONCLUSION When performed in appropriate settings following close liaison with referring physicians, percutaneous renal angioplasty and stenting remains an important treatment modality for renovascular disease.
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Affiliation(s)
- H K Kok
- Department of Radiology, Tallaght Hospital, Tallaght, Dublin 24, Ireland.
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122
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Prajapati H, McCallum A, Finlay E. Hypertension, secondary to a renal artery aneurysm, treated by ex vivo aneurysm repair and autotransplantation. BMJ Case Rep 2012; 2012:bcr-2012-007362. [PMID: 23166176 DOI: 10.1136/bcr-2012-007362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypertension is becoming a more common problem in childhood and adolescence. About 5-10% of paediatric patients with hypertension have underlying renovascular disease. Although renal artery aneurysms (RAAs) are an uncommon cause of disease of the renal vessels, they are recognised as a cause of hypertension. We describe a 15-year-old man with symptomatic hypertension who after extensive investigation was found to have a right RAA. Our patient responded to conservative management with two antihypertensive agents, but as a young sports enthusiast, he was keen to pursue more definitive options. Complex anatomy of the aneurysm precluded the use of endovascular treatment. Surgical options were explored, and after counselling, our patient underwent a nephrectomy, ex vivo aneurysm repair and autotransplantation with which his hypertension resolved. Our case highlights the difficulty of diagnosing RAAs in hypertensive patients and that, in carefully selected patients, invasive surgical intervention of RAAs is a viable treatment option.
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Affiliation(s)
- Hitesh Prajapati
- Department of Paediatric Nephrology, Leeds Teaching Hospitals Trust, Leeds, UK.
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123
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Poloskey SL, Kim ES, Sanghani R, Al-Quthami AH, Arscott P, Moran R, Rigelsky CM, Gornik HL. Low yield of genetic testing for known vascular connective tissue disorders in patients with fibromuscular dysplasia. Vasc Med 2012; 17:371-8. [PMID: 23064905 DOI: 10.1177/1358863x12459650] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with fibromuscular dysplasia (FMD) may have clinical features consistent with Mendelian vascular connective tissue disorders. The yield of genetic testing for these disorders among patients with FMD has not been determined. A total of 216 consecutive patients with FMD were identified. Clinical characteristics were collected and genetic test results reviewed for abnormalities in the following genes: transforming growth factor-β receptor 1 and 2 (TGFβR1 and TGFβR2), collagen 3A1, fibrillin-1, smooth muscle α-actin 2, and SMAD3. A total of 63 patients (63/216; 29.2%) were referred for genetic counseling with testing performed in 35 (35/63; 55.6%). The percentage of patients with a history of arterial or aortic dissection, history of aortic aneurysm, systemic features of a connective tissue disorder, and a family history of sudden death was significantly larger in the group that underwent genetic testing (62.9% vs 18.2%, p < 0.001; 8.6% vs 1.7%, p = 0.02; 51.4% vs 17.1%, p < 0.001; and 42.9% vs 22.7%, p = 0.04, respectively). Two patients were found to have distinct variants in the TGFβR1 gene (c.611 C>T, p.Thr204lle and c.1285 T>C, p.Tyr429His). The yield of genetic testing for vascular connective tissue disorders was low in a high-risk subset of FMD patients. However, two patients with a similar phenotype had novel and distinct variants in the TGFβR1 gene, a finding which merits further investigation.
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Affiliation(s)
- Stacey L Poloskey
- Cleveland Clinic Heart and Vascular Institute and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
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124
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Mortensen KH, Andersen NH, Gravholt CH. Cardiovascular phenotype in Turner syndrome--integrating cardiology, genetics, and endocrinology. Endocr Rev 2012; 33:677-714. [PMID: 22707402 DOI: 10.1210/er.2011-1059] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is emerging as a cardinal trait of Turner syndrome, being responsible for half of the 3-fold excess mortality. Turner syndrome has been proposed as an independent risk marker for cardiovascular disease that manifests as congenital heart disease, aortic dilation and dissection, valvular heart disease, hypertension, thromboembolism, myocardial infarction, and stroke. Risk stratification is unfortunately not straightforward because risk markers derived from the general population inadequately identify the subset of females with Turner syndrome who will suffer events. A high prevalence of endocrine disorders adds to the complexity, exacerbating cardiovascular prognosis. Mounting knowledge about the prevalence and interplay of cardiovascular and endocrine disease in Turner syndrome is paralleled by improved understanding of the genetics of the X-chromosome in both normal health and disease. At present in Turner syndrome, this is most advanced for the SHOX gene, which partly explains the growth deficit. This review provides an up-to-date condensation of current state-of-the-art knowledge in Turner syndrome, the main focus being cardiovascular morbidity and mortality. The aim is to provide insight into pathogenesis of Turner syndrome with perspectives to advances in the understanding of genetics of the X-chromosome. The review also incorporates important endocrine features, in order to comprehensively explain the cardiovascular phenotype and to highlight how raised attention to endocrinology and genetics is important in the identification and modification of cardiovascular risk.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark
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125
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Abstract
PURPOSE OF REVIEW Pulsatile tinnitus is an uncommon otologic symptom, which often presents a diagnostic and management dilemma to the otolaryngologist. The majority of patients with pulsatile tinnitus have a treatable cause. Failure to establish correct diagnosis may have disastrous consequences, because a potentially life-threatening, underlying disorder may be present. The purpose of this review is to familiarize the otolaryngologist with the most common causes, evaluation, and management of pulsatile tinnitus. RECENT FINDINGS The pathophysiology, classification, various causes, evaluation, and management of the most common causes of pulsatile tinnitus are presented in this review. SUMMARY Pulsatile tinnitus deserves a thorough evaluation and, in the majority of cases, there is a treatable underlying cause. The possibility of a life-threatening cause needs to be ruled out in every patient with pulsatile tinnitus. The otolaryngologist should be familiar with the evaluation and management of this symptom.
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126
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Perforation during stenting of a coronary artery with morphologic changes of fibromuscular dysplasia: an unrecognized risk with percutaneous intervention. Can J Cardiol 2012; 29:519.e1-3. [PMID: 22902151 DOI: 10.1016/j.cjca.2012.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/13/2012] [Accepted: 06/13/2012] [Indexed: 11/22/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is increasingly recognized as a nonatherosclerotic pathology in young women presenting with acute coronary syndromes. The angiographic appearance of these lesions may mimic typical atherosclerosis, and a high index of suspicion is needed. The pathophysiological changes in the intima and media alter the vessel's elasticity and may adversely affect the lesion's response to balloon dilatation and stenting. Intracoronary imaging is therefore useful when planning percutaneous intervention. We present a case of stent implantation in a coronary FMD lesion complicated by perforation with intravascular ultrasound images demonstrating the typical changes of FMD.
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127
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Tan WH, Egyhazi R, Isaac Z. C6 radiculopathy: the initial presentation of fibromuscular dysplasia. PM R 2012; 4:527-9. [PMID: 22814731 DOI: 10.1016/j.pmrj.2012.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Wei-Han Tan
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA
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128
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Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJM, Rihal CS, Gulati R. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation 2012; 126:579-88. [PMID: 22800851 DOI: 10.1161/circulationaha.112.105718] [Citation(s) in RCA: 602] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized. METHODS AND RESULTS A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes, and long-term risk of SCAD recurrence or major adverse cardiac events were evaluated. Mean age was 42.6 years; 82% were female. Extreme exertion at SCAD onset was more frequent in men (7 of 16 versus 2 of 71; P<0.001), and postpartum status was observed in 13 of 71 women (18%). Presentation was ST-elevation myocardial infarction in 49%. Multivessel SCAD was found in 23%. Initial conservative management (31 of 87) and coronary artery bypass grafting (7 of 87) were associated with an uncomplicated in-hospital course, whereas percutaneous coronary intervention was complicated by technical failure in 15 of 43 patients (35%) and 1 death. During a median follow-up of 47 months (interquartile range, 18-106 months), SCAD recurred in 15 patients, all female. Estimated 10-year rate of major adverse cardiac events (death, heart failure, myocardial infarction, and SCAD recurrence) was 47%. Fibromuscular dysplasia of the iliac artery was identified incidentally in 8 of 16 femoral angiograms (50%) undertaken before closure device placement and in the carotid arteries of 2 others with carotid dissection. CONCLUSIONS SCAD affects a young, predominantly female population, frequently presenting as ST-elevation myocardial infarction. Although in-hospital mortality is low regardless of initial treatment, percutaneous coronary intervention is associated with high rates of complication. Risks of SCAD recurrence and major adverse cardiac events in the long term emphasize the need for close follow-up. Fibromuscular dysplasia is a novel association and potentially causative factor.
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Affiliation(s)
- Marysia S Tweet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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129
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130
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Hyun CL, Park HS, Shin HJ, Yoon SP. Hypoplasia of left vertebral artery with intimal fibromuscular dysplasia in a Korean woman. J Korean Med Sci 2012; 27:811-3. [PMID: 22787380 PMCID: PMC3390733 DOI: 10.3346/jkms.2012.27.7.811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/28/2012] [Indexed: 11/26/2022] Open
Abstract
We found a case of hypoplasia of vertebral artery with fibromuscular dysplasia in an 82-yr-old Korean female cadaver during a routine dissection course. In the present case, intracranial hypoplasia in left vertebral artery and bilateral origin of posterior inferior cerebellar artery at the vertebrobasilar junction were recognized. Histopathologically, left vertebral artery showed intimal type of fibromuscular dysplasia both in its extracranial and intracranial courses. These results indicate that the association of fibromuscular dysplasia and hypoplasia does exist in the vertebral artery, although the etiologies are not verified yet.
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Affiliation(s)
- Chang Lim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Sik Park
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Jo Shin
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Pil Yoon
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
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131
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Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, Jaff MR, Kim ESH, Mace P, Matsumoto AH, McBane RD, Kline-Rogers E, White CJ, Gornik HL. The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation 2012; 125:3182-90. [PMID: 22615343 DOI: 10.1161/circulationaha.112.091223] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fibromuscular dysplasia (FMD), a noninflammatory disease of medium-size arteries, may lead to stenosis, occlusion, dissection, and/or aneurysm. There has been little progress in understanding the epidemiology, pathogenesis, and outcomes since its first description in 1938. METHODS AND RESULTS Clinical features, presenting symptoms, and vascular events are reviewed for the first 447 patients enrolled in a national FMD registry from 9 US sites. Vascular beds were imaged selectively based on clinical presentation and local practice. The majority of patients were female (91%) with a mean age at diagnosis of 51.9 (SD 13.4 years; range, 5-83 years). Hypertension, headache, and pulsatile tinnitus were the most common presenting symptoms of the disease. Self-reported family history of stroke (53.5%), aneurysm (23.5%), and sudden death (19.8%) were common, but FMD in first- or second-degree relatives was reported only in 7.3%. FMD was identified in the renal artery in 294 patients, extracranial carotid arteries in 251 patients, and vertebral arteries in 82 patients. A past or presenting history of vascular events were common: 19.2% of patients had a transient ischemic attack or stroke, 19.7% had experienced arterial dissection(s), and 17% of patients had an aneurysm(s). The most frequent indications for therapy were hypertension, aneurysm, and dissection. CONCLUSIONS In this registry, FMD occurred primarily in middle-aged women, although it presents across the lifespan. Cerebrovascular FMD occurred as frequently as renal FMD. Although a significant proportion of FMD patients may present with a serious vascular event, many present with nonspecific symptoms and a subsequent delay in diagnosis.
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Affiliation(s)
- Jeffrey W Olin
- Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1033, New York, NY 10029, USA.
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132
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Bulder MMM, Braun KPJ, Leeuwis JW, Lo RTH, van Nieuwenhuizen O, Kappelle LJ, Klijn CJM. The course of unilateral intracranial arteriopathy in young adults with arterial ischemic stroke. Stroke 2012; 43:1890-6. [PMID: 22550051 DOI: 10.1161/strokeaha.112.653212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Unilateral intracranial focal nonprogressive arteriopathy is often found in children with arterial ischemic stroke. We aimed to investigate the course of unilateral intracranial arteriopathy in young adults. METHODS We searched the Utrecht Stroke Database for patients between 16 and 50 years of age diagnosed with anterior circulation arterial ischemic stroke and a nonatherosclerotic, unilateral intracranial large-artery arteriopathy between 1991 and 2005. We assessed clinical features, potential causes, risk factors, extent of infarction and arteriopathy at presentation, long-term angiographic course, and clinical outcome. RESULTS Of 356 patients with anterior circulation arterial ischemic stroke, 17 (5%) had a documented unilateral intracranial arteriopathy, of whom 14 could be included for follow-up investigations (median age, 34 years; range, 27-49 years). Median duration of follow-up was 8.8 years (range, 1.7-12.8 years). In 11 patients, onset of symptoms was not abrupt. The arteriopathy normalized completely in 5 and improved in 3 patients; in none of the patients did the arteriopathy worsen. Two of 14 patients had recurrent symptoms. Ten patients (71%) had a good outcome (modified Rankin Scale score≤2). CONCLUSIONS In young adults, arterial ischemic stroke is rarely caused by a unilateral intracranial arteriopathy. Similar to children, onset of symptoms in young adults is often not abrupt and the arteriopathy may improve over time. Late recurrences were rare. Possibly, a monophasic inflammatory process, as has been suggested for childhood intracranial focal nonprogressive arteriopathies, also occurs in young adults.
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Affiliation(s)
- Marcel M M Bulder
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, HP G03.228, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Rastogi N, Kabutey NK, Kim D, Farber A. Symptomatic fibromuscular dysplasia of the external iliac artery. Ann Vasc Surg 2012; 26:574.e9-13. [PMID: 22410140 DOI: 10.1016/j.avsg.2011.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/03/2011] [Accepted: 09/12/2011] [Indexed: 12/18/2022]
Abstract
The aim of this article is to report a case of symptomatic fibromuscular dysplasia (FMD) involving the external iliac arteries (EIAs). An 88-year-old woman was admitted to the vascular service, with a painful right posterior ankle ulcer that had progressively worsened during the course of a month. Her medical history included diabetes and hypertension. Bilateral lower-extremity pulses were absent, and femoral and tibial Doppler waveforms were monophasic. Pelvic and bilateral lower-extremity angiograms were obtained, which revealed findings in both EIAs consistent with a diagnosis of extrarenal FMD. Percutaneous transluminal angioplasty with subsequent stenting of the right EIA was performed, using a self-expanding stent. Completion digital subtraction angiography demonstrated a widely patent right EIA with brisk flow of contrast across the stent. Postprocedural arterial duplex scan showed a biphasic waveform pattern in the common femoral artery. FMD can involve the EIA and be associated with critical limb ischemia. FMD of the EIA responds well to endovascular management.
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Affiliation(s)
- Neeraj Rastogi
- Department of Radiology, Boston Medical Center, Boston, Massachusetts 02118, USA.
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134
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Persu A, Touzé E, Mousseaux E, Barral X, Joffre F, Plouin PF. Diagnosis and management of fibromuscular dysplasia: an expert consensus. Eur J Clin Invest 2012; 42:338-47. [PMID: 21854373 DOI: 10.1111/j.1365-2362.2011.02577.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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135
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Affiliation(s)
- Aditya M. Sharma
- From Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Heather L. Gornik
- From Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
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Mousa AY, Campbell JE, Stone PA, Broce M, Bates MC, AbuRahma AF. Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period. J Vasc Surg 2012; 55:421-7. [DOI: 10.1016/j.jvs.2011.09.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 11/29/2022]
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137
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Liu CH, Wu D, Chin SC, Fu SC, Wu TC, Chang CH, Peng TI, Chang YJ, Lee TH. Cervicocranial Fibromuscular Dysplasia in Taiwanese Ischemic Stroke Patients. Eur Neurol 2012; 67:129-35. [DOI: 10.1159/000331623] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/26/2011] [Indexed: 11/19/2022]
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139
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Lambert M, Hatron PY. Artérite du sujet jeune : éléments d’orientation du diagnostic étiologique. Presse Med 2011; 40:707-12. [DOI: 10.1016/j.lpm.2011.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
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140
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Bornak A, Milner R. Diagnosing and Treating Atypical Arterial Pathologies of Aortic Arch Vessels: Dissection and Fibromuscular Dysplasia. Semin Vasc Surg 2011; 24:36-43. [DOI: 10.1053/j.semvascsurg.2011.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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141
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Conforto AB. Multicenter studies to shed light on fibromuscular displasia and cervical artery dissection. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:275-276. [PMID: 21625749 DOI: 10.1590/s0004-282x2011000300001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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