1
|
Percutaneous cutting balloon angioplasty for the treatment of renovascular hypertension in children and adolescents. J Hypertens 2022; 40:1902-1908. [PMID: 35983863 DOI: 10.1097/hjh.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Percutaneous transluminal renal angioplasty (PTRA), the recommended treatment in children with renovascular hypertension (RVH), often has unsatisfactory outcomes. Cutting balloons may improve the results of angioplasty in different vascular beds with complex and resistant lesions. We retrospectively analysed the effects of percutaneous cutting balloon angioplasty (PCBA) on blood pressure, cardiac mass and renal artery acceleration time in children/adolescents referred to our centre for RVH. PATIENTS AND METHODS Thirteen patients (aged 9-19 years) with renal artery stenosis (RAS) and severe hypertension were identified. RASs were focal fibromuscular (FMD) or FMD-like dysplasia (in six cases bilateral, in five associated with mid aortic syndrome). Ten patients had uncontrolled hypertension, in nine cases associated with left ventricular hypertrophy (LVH). Acceleration time was abnormal in all stenotic arteries. Eighteen PCBA were performed, in three arteries associated with stent implantation. RESULTS PCBA was technically successful in all individuals without major complications. In one patient, an intra-stent restenosis occurred, successfully redilated with conventional angioplasty without recurrence at 4 years distance. One year after PCBA, mean SBP and DBPs were markedly reduced from 146 ± 25 to 121 ± 10 mmHg and from 87 ± 11 to 65 ± 12 mmHg, respectively (P < 0.001 for both). At that time, hypertension was cured in seven children and controlled in five individuals. This favourable outcome was confirmed with ambulatory blood pressure measurement in four patients. At the latest follow-up, left ventricular mass and acceleration time were normal in all patients. CONCLUSION PCBA proved to be a well tolerated and effective procedure that can be considered as an alternative to PTRA to treat hypertensive children/adolescents with recurrent or resistant RAS.
Collapse
|
2
|
Vijayvergiya R, Jindal AK, Pilania RK, Suri D, Gupta A, Sharma A, Sinha SK, Singhal M, Bahl A, Singh S. Complex interventions of abdominal aorta and its branches in children with Takayasu arteritis: Clinical experience from a tertiary care center in north-west India. Int J Rheum Dis 2018; 22:140-151. [PMID: 30398008 DOI: 10.1111/1756-185x.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/04/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ankur K. Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Rakesh K. Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Deepti Suri
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Ashish Sharma
- Department of Renal Transplant Surgery; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Saroj K. Sinha
- Department of Gastroenterology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ajay Bahl
- Department of Cardiology, Advanced Cardiac Centre; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| |
Collapse
|
3
|
Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results. Cardiovasc Intervent Radiol 2016; 40:546-552. [PMID: 28035431 DOI: 10.1007/s00270-016-1536-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD). MATERIALS AND METHODS From 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years. RESULTS All treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA. CONCLUSION Results show the efficacy of CBA for renal artery FMD.
Collapse
|
4
|
Xiao Y, Zhou J, Wei X, Sun Y, Zhang L, Feng J, Feng R, Zhao Z, Jing Z. Outcomes of different treatments on Takayasu's arteritis. J Thorac Dis 2016; 8:2495-2503. [PMID: 27747001 DOI: 10.21037/jtd.2016.08.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) is a nonspecific chronic inflammation of the aorta and its branches. This study compared the outcomes of surgical treatments including bypass surgery, cutting balloon angioplasty and conventional balloon angioplasty to TA patients exhibiting supra-aortic arterial (SAA). METHODS This retrospective study was conducted on 42 TA patients, obtained from hospital database, who underwent surgical therapy due to SAA lesions from January 2010 to March 2015. Ten patients were reconstructed using cutting balloon angioplasty, 16 patients received conventional balloon angioplasty and 16 patients from bypass surgery. The primary patency, recurrent symptoms, re-intervention, early (<30 days) and late complications associated with treatment were evaluated. RESULTS In the conventional balloon angioplasty group, two patients were converted to bypass surgery as the guidewire could not traverse the lesions. The follow-up at 30.07±17.96 months (range, 1-60 months) showed restenosis or occlusion development in 40.9% arteries in conventional balloon angioplasty, compared with 6.3% after bypass surgery (P=0.018). The restenosis or occlusion rate between cutting balloon angioplasty and conventional balloon angioplasty groups were insignificant (P=0.738). In the re-intervention, three out of four (75%) treated by cutting balloon angioplasty were patent as compared to the three out of nine arteries (33.3%) dealt with by conventional angioplasty that was patent (P=0.266). Intracerebral hemorrhage (n=1) was developed in the bypass surgery group. Mortality was not observed in any of the groups. CONCLUSIONS Cutting balloon angioplasty can be considered as a safe, effective, and less-invasive alternative for non-diffuse SAA lesions, especially in young TA patients. However, bypass surgery has better primary patency rate than endovascular treatment.
Collapse
Affiliation(s)
- Yu Xiao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yudong Sun
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| |
Collapse
|
5
|
Fritz Angle J, Nida BA, Matsumoto AH. Endovascular Treatment of Large Vessel Arteritis. Tech Vasc Interv Radiol 2014; 17:252-7. [DOI: 10.1053/j.tvir.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
6
|
Meyers KE, Cahill AM, Sethna C. Interventions for Pediatric Renovascular Hypertension. Curr Hypertens Rep 2014; 16:422. [DOI: 10.1007/s11906-014-0422-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
7
|
Aortorenal Bypass with Autologous Saphenous Vein in Takayasu Arteritis-induced Renal Artery Stenosis. Eur J Vasc Endovasc Surg 2011; 42:47-53. [DOI: 10.1016/j.ejvs.2011.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/09/2011] [Indexed: 11/23/2022]
|
8
|
Srinivasan A, Krishnamurthy G, Fontalvo-Herazo L, Nijs E, Meyers K, Kaplan B, Cahill AM. Spectrum of renal findings in pediatric fibromuscular dysplasia and neurofibromatosis type 1. Pediatr Radiol 2011; 41:308-16. [PMID: 20953597 DOI: 10.1007/s00247-010-1854-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 08/01/2010] [Accepted: 09/01/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fibromuscular dysplasia (FMD) and neurofibromatosis type 1 (NF1) are the most common causes of pediatric renal artery stenosis (RAS) in western countries, and characterization of their angiographic features could aid in an accurate diagnosis and in treatment. OBJECTIVE This study characterizes renal angiographic findings in pediatric fibromuscular dysplasia (FMD) and neurofibromatosis type 1(NF1). MATERIALS AND METHODS We reviewed 68 angiograms performed over 11 years on 43 children with renovascular hypertension (20 male, 23 females; ages 1 month to -19 years; median/average 9.8 years). Ten patients were diagnosed with NF1, and 33 had presumed FMD. The frequency, extent and distribution of lesions were determined and analyzed. RESULTS Stenosis was found in 91% of patients (n=39/43), with 86% showing stenosis of 1st or 2nd order arteries, and 12% distal to 2nd order. Stenoses in multiple 1st/2nd order arteries were found in 32% of patients, and 36/43 patients had 1-2 stenoses. The most common lesion was a ≤ 5 mm stenosis in a 1st/2nd order artery, in 42%. Mean percentage of stenosis in a 1st/2nd order vessel was 62%; ≥ 70% stenosis was found in 53%, and ≥ 90% stenosis in 29%. Bilateral disease was noted in 30% of patients. Intraparenchymal disease, distal to 2nd order branches, was seen in 30%. Aneurysms were seen in 28%, beading in 19% and collaterals in 51% (associated with ≥ 70% stenosis). Mid-aortic narrowing was seen in 16%, more often in patients with NF1. CONCLUSION We provide a descriptive characterization of renal angiographic findings in pediatric FMD and NF1.
Collapse
Affiliation(s)
- Abhay Srinivasan
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Angioplasty for Renal Artery Stenosis in Pediatric Patients: An 11-year Retrospective Experience. J Vasc Interv Radiol 2010; 21:1672-80. [DOI: 10.1016/j.jvir.2010.07.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 03/10/2010] [Accepted: 07/08/2010] [Indexed: 11/24/2022] Open
|
10
|
Yoo SH, Kim GH, Lee WI, Kwon SK, Lee SY, Bae JW, Hwang KK, Kim DW, Cho MC. Successful Percutaneous Renal Artery Angioplasty and Stenting for Acute Oliguric Renal Failure in a Solitary Functioning Kidney Caused by Takayasu's Arteritis. Korean Circ J 2010; 40:414-7. [PMID: 20830257 PMCID: PMC2933468 DOI: 10.4070/kcj.2010.40.8.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 01/26/2010] [Accepted: 01/27/2010] [Indexed: 11/11/2022] Open
Abstract
Takayasu's arteritis (TA) is a nonspecific, chronic and stenotic panarteritis which usually involves the aorta and its major branches. Corticosteroid and immunosuppressants are recommended to manage the acute inflammatory phase, but their long term benefits are uncertain. Blood pressure (BP) control during the chronic phase of TA is essential to preserve renal function, which is associated with the patient's long-term prognosis and survival. Revascularization in organ damaging arterial stenosis with percutaneous angioplasty (PTA)/stenting or bypass surgery have been accepted as established treatment options in chronic complicated phase of TA. We present a case of a 31-year-old female patient with a two-day history of sudden onset oliguria and generalized edema whose acute oliguric renal failure was successfully reversed following PTA and stenting in a solitary functioning kidney with critical renal artery stenosis (RAS) caused by TA.
Collapse
Affiliation(s)
- Suk-Hee Yoo
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Ravel A, Boyer L, Rousseau H, Raynaud A, Vernhet Kovacsik H. [State of the art: interventional radiology management of renovascular hypertension]. JOURNAL DE RADIOLOGIE 2010; 91:819-822. [PMID: 20814369 DOI: 10.1016/s0221-0363(10)70123-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The management of renal artery stenosis (RAS) has been the subject of numerous clinical studies and recommendations, most frequently with regards to atherosclerotic RAS. We present the current recommendations from the French Society of Cardiac and Vascular Imaging updated from a recent literature review (April 2008) with regards to medical, endovascular and surgical management of atheroscletotic and non-atherosclerotic RAS. The evidence-based recommendations are ranked by level.
Collapse
Affiliation(s)
- A Ravel
- Service de Radiologie, Hôpital Gabriel Montpied, 53, rue Montalembert, 63003 Clermont-Ferrand cedex 1
| | | | | | | | | |
Collapse
|
12
|
Cutting-Balloon Angioplasty in Transplant Renal Artery Stenosis as First-Line Treatment in the Early Postoperative Period. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S70-3. [DOI: 10.1007/s00270-010-9930-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
|
13
|
Meuse MA, Turba UC, Sabri SS, Park AW, Saad WE, Angle JF, Matsumoto AH. Treatment of Renal Artery Fibromuscular Dysplasia. Tech Vasc Interv Radiol 2010; 13:126-33. [DOI: 10.1053/j.tvir.2010.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Anchala PR, Resnick SA. The current state of endovascular therapy in the evaluation and management of renovascular disease. Semin Intervent Radiol 2009; 26:333-44. [PMID: 21326543 DOI: 10.1055/s-0029-1242202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypertension is the most common reason for physician office visits among nonpregnant adults in the United States; up to one-third of Americans over the age of 18 have been diagnosed with hypertension. Patients with physiologically significant renal artery stenosis often go unnoticed because hypertension can often be well controlled with antihypertensive medications. As a result, screening for renovascular causes of hypertension is rarely done. However, the likelihood of renovascular disease increases in patients with acute, severe, or refractory hypertension and should be explored in patients who fall into these categories. Renovascular disease is a crucial consideration in the management of hypertension due to its increasing incidence and its potential for reversibility. Although renovascular disease accounts for less than 1% of patients with mild hypertension, it is estimated that between 10 and 45% of white patients with severe or malignant hypertension have renal artery stenosis (RAS). In this population, diagnosing and treating RAS can have a profound and long-lasting effect on the treatment of hypertension.
Collapse
Affiliation(s)
- Praveen R Anchala
- Department of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | |
Collapse
|
15
|
Renal artery rupture following cutting balloon angioplasty for fibromuscular dysplasia: a case report. CASES JOURNAL 2009. [PMID: 20184703 PMCID: PMC2827089 DOI: 10.4076/1757-1626-2-8881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Angioplasty with the use of cutting balloons has been suggested by some case reports and small series for the treatment of renal artery stenoses that are resistant to conventional balloon catheters. Based on this limited experience, the use of this technology has been suggested as safe. Herein, we report a renal artery rupture following angioplasty with a cutting balloon. The complication was salvaged with a stent graft. Case presentation A 30-year-old white female patient with resistant hypertension caused by a severe renal artery stenosis attributed to fibromuscular dysplasia, was submitted to conventional balloon angioplasty without success. Dilatation of the lesion with a cutting balloon resulted in arterial rupture, with concomitant retroperitoneal hematoma. Conclusion Cutting balloon angioplasty of renal artery lesions resistant to conventional balloon angioplasty should not be considered as safe as previously thought. When proceeding with such a procedure, a stent graft should be available for immediate use.
Collapse
|
16
|
Brountzos EN, Ptohis N, Triantafyllidi H, Panagiotou I, Spyridopoulos TN, Misiakos EP, Kelekis A. Renal artery rupture following cutting balloon angioplasty for fibromuscular dysplasia: a case report. CASES JOURNAL 2009; 2:8881. [PMID: 20184703 DOI: 10.1186/1757-1626-0002-0000008881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/24/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Angioplasty with the use of cutting balloons has been suggested by some case reports and small series for the treatment of renal artery stenoses that are resistant to conventional balloon catheters. Based on this limited experience, the use of this technology has been suggested as safe. Herein, we report a renal artery rupture following angioplasty with a cutting balloon. The complication was salvaged with a stent graft. CASE PRESENTATION A 30-year-old white female patient with resistant hypertension caused by a severe renal artery stenosis attributed to fibromuscular dysplasia, was submitted to conventional balloon angioplasty without success. Dilatation of the lesion with a cutting balloon resulted in arterial rupture, with concomitant retroperitoneal hematoma. CONCLUSION Cutting balloon angioplasty of renal artery lesions resistant to conventional balloon angioplasty should not be considered as safe as previously thought. When proceeding with such a procedure, a stent graft should be available for immediate use.
Collapse
Affiliation(s)
- Elias N Brountzos
- Department of Radiology, Athens University Medical School, Attikon University Hospital, 1 Rimini St., 12462, Chaidari, Greece.
| | | | | | | | | | | | | |
Collapse
|
17
|
Gumus B, Cevik H, Vuran C, Omay O, Kocyigit OI, Turkoz R. Cutting balloon angioplasty of bilateral renal artery stenosis due to Takayasu arteritis in a 5-year-old child with midterm follow-up. Cardiovasc Intervent Radiol 2009; 33:394-7. [PMID: 19517163 DOI: 10.1007/s00270-009-9623-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 05/09/2009] [Accepted: 05/14/2009] [Indexed: 02/06/2023]
Abstract
The aim of this report is to demonstrate the successful endovascular treatment of bilateral renal artery stenosis due to Takayasu arteritis by cutting balloon angioplasty in a 5-year-old child with mid-term follow-up.
Collapse
Affiliation(s)
- Burcak Gumus
- Department of Radiology, Baskent University Hospital, Oymaci Sok. No. 7, Altunizade, Usküdar, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
18
|
Peregrin JH, Bürgelová M. Restoration of failed renal graft function after successful angioplasty of pressure-resistant renal artery stenosis using a cutting balloon: a case report. Cardiovasc Intervent Radiol 2008; 32:548-53. [PMID: 18756369 DOI: 10.1007/s00270-008-9420-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 07/24/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
Abstract
This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 micromol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 micromol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m(2). The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.
Collapse
Affiliation(s)
- J H Peregrin
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
| | | |
Collapse
|
19
|
|
20
|
Doody O, Adam WR, Foley PT, Lyon SM. Fibromuscular Dysplasia Presenting with Bilateral Renal Infarction. Cardiovasc Intervent Radiol 2008; 32:329-32. [PMID: 18509702 DOI: 10.1007/s00270-008-9363-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 05/05/2008] [Accepted: 05/07/2008] [Indexed: 11/30/2022]
Affiliation(s)
- O Doody
- Department of Radiology, The Alfred Hospital, Commercial Road, Melbourne, Australia.
| | | | | | | |
Collapse
|
21
|
Giavroglou C, Tsifountoudis I, Boutzetis T, Kiskinis D. Failure and success of percutaneous angioplasty in a hypertensive child with bilateral renal artery stenosis. Cardiovasc Intervent Radiol 2008; 32:150-4. [PMID: 18443856 DOI: 10.1007/s00270-008-9350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 03/31/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
Abstract
We describe the clinical course of a 5-year-old girl with severe arterial hypertension that was uncontrollable with antihypertensive medication. Renal angiography revealed bilateral renal artery stenoses. Because percutaneous transluminal renal angioplasty (PTRA) failed to dilate the stenotic lesions, a renal artery bypass grafting in both renal arteries was performed. The patient remained normotensive for 7 months, and after that the arterial pressure increased again. Digital subtraction angiography demonstrated stenosis at the peripheral and central anastomosis of the vein graft that was used for revascularization of the left kidney. PTRA was decided on and successful patency was achieved. The patient has now been normotensive for a period of 5 years.
Collapse
Affiliation(s)
- Constantinos Giavroglou
- Department of Radiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | |
Collapse
|