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Goodman J, Kulkarni S, Selvarajah V, Hilliard N, Russell N, Wilkinson IB. Renal Autotransplantation for Uncontrolled Hypertension in Nonatherosclerotic Renal Artery Stenosis-2 Case Reports and a Brief Review of the Literature. Hypertension 2024; 81:669-675. [PMID: 38507507 DOI: 10.1161/hypertensionaha.123.19878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Fibromuscular dysplasia is the most common cause of renovascular hypertension in young adults under 40 years old. It is potentially amenable to renal artery angioplasty, which frequently normalizes blood pressure. However, limited options exist if angioplasty is not technically possible, or restenosis occurs. Here, we describe 2 patients who presented with hypertension secondary to renal artery stenosis. In the first case, a young adult with hypertension secondary to renal artery stenosis (fibromuscular dysplasia), developed restenosis 11 weeks after an initially successful renal artery angioplasty. In the second case, a patient with neurofibromatosis type 1 was diagnosed with hypertension secondary to renal artery stenosis. Angioplasty was not possible due to multiple branch occlusions. Both individuals went on to have successful renal autotransplantations, which ultimately cured their hypertension. In this article, we review the background, indications, and blood pressure outcomes in relation to renal autotransplantation in nonatherosclerotic renal artery stenosis.
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Affiliation(s)
- James Goodman
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Spoorthy Kulkarni
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (S.K., I.B.W.)
| | - Viknesh Selvarajah
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Nicholas Hilliard
- Department of Radiology (N.H.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Neil Russell
- Department of Transplant Surgery (N.R.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Ian B Wilkinson
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (S.K., I.B.W.)
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Kądziela J, Jóźwik-Plebanek K, Pappaccogli M, van der Niepen P, Prejbisz A, Dobrowolski P, Michałowska I, Talarowska P, Warchoł-Celińska E, Stryczyński Ł, Krekora J, Andziak P, Szczerbo-Trojanowska M, Maciąg R, Sterliński I, Witkowski A, Januszewicz A, Adlam D, Januszewicz M, Persu A. Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study. Vasc Med 2024; 29:50-57. [PMID: 38084723 DOI: 10.1177/1358863x231210523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the study was to retrospectively analyze the immediate and long-term results of renal stenting versus angioplasty in patients with FMD. METHODS Of 343 patients in the ARCADIA-POL registry, 58 patients underwent percutaneous treatment due to FMD-RAS (in 70 arteries). Percutaneous transluminal renal angioplasty (PTRA) was performed as an initial treatment in 61 arteries (PTRA-group), whereas primary stenting was undertaken in nine arteries (stent-group). Stent-related complications were defined as: in-stent restenosis > 50% (ISR); stent fracture; under-expansion; or migration. RESULTS In the PTRA-group, the initial restenosis rate was 50.8%. A second procedure was then performed in 22 arteries: re-PTRA (12 arteries) or stenting (10 arteries). The incidence of recurrent restenosis after re-PTRA was 41.7%. Complications occurred in seven of 10 (70%) arteries secondarily treated by stenting: two with under-expansion and five with ISR. In the stent-group, stent under-expansion occurred in one case (11.1%) and ISR in three of nine stents (33.3%). In combined analysis of stented arteries, either primarily or secondarily, stent-related complications occurred in 11/19 stenting procedures (57.9%): three due to under-expansion and eight due to ISRs. Finally, despite several revascularization attempts, four of 19 (21%) stented arteries were totally occluded and one was significantly stenosed at follow-up imaging. CONCLUSION Our study indicates that renal stenting in FMD-RAS may carry a high risk of late complications, including stent occlusion. Further observational data from large-scale registries are required.
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Affiliation(s)
- Jacek Kądziela
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | | | - Marco Pappaccogli
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy
| | - Patricia van der Niepen
- Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (VUB), Brussels, Belgium
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Ilona Michałowska
- Department of Radiology, National Institute of Cardiology, Warsaw, Poland
| | - Paulina Talarowska
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | | | - Łukasz Stryczyński
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Jan Krekora
- Department of Cardiology, Medical University of Łódź, Łódź, Poland
| | - Piotr Andziak
- 2nd Second Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | | | - Rafał Maciąg
- 2nd Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Ignacy Sterliński
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - David Adlam
- Department of Cardiovascular Sciences and Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester University, Leicester, UK
| | | | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Viertel A, Breese N, Krist L, Groenefeld G. A Renal Artery Stenting Case: Support for Increased Use of Drug-Eluting Stents. Int J Angiol 2023; 32:284-287. [PMID: 37927837 PMCID: PMC10624529 DOI: 10.1055/s-0041-1741470] [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: 10/19/2022] Open
Abstract
Fibromuscular dysplasia is a rare, systemic arteriovascular disease that often affects the renal arteries. Balloon angioplasty is recommended for uncontrolled hypertension and compromised renal function; stenting is a bailout option. Drug-eluting stents have been suggested in case reports. We report the successful intervention with an everolimus-coated stent in a very young patient. The patient was followed for 2 years after placing the stent. The success of this case suggests that drug-eluting stents should be used more frequently in comparable situations.
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Affiliation(s)
- Achim Viertel
- Asklepios Klinik Barmbek-Cardiology, Ruebenkamp 220, Hamburg, Germany
| | - Nils Breese
- Nephrocare Hamburg-Barmbek, Hebebrandstrasse 6, Hamburg, Germany
| | - Lars Krist
- Asklepios Klinik Barmbek-Cardiology, Ruebenkamp 220, Hamburg, Germany
| | - Gerian Groenefeld
- Asklepios Klinik Barmbek-Cardiology, Ruebenkamp 220, Hamburg, Germany
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Lu YT, Zhou ZM, Zhang D, Sun L, Liu XC, Yang YK, Jiang XJ, Zhou XL. Percutaneous Transluminal Renal Angioplasty for Fibromuscular Dysplasia and Prognostic Risk Factors: A Retrospective Chinese Cohort Study. J Clin Med 2022; 12:jcm12010023. [PMID: 36614824 PMCID: PMC9821653 DOI: 10.3390/jcm12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease involving small-to-medium-sized arteries. The characteristics of Chinese patients with FMD remain unclear. We retrospectively analyzed the data of patients with renal FMD who underwent percutaneous transluminal renal angioplasty (PTRA) for the first time at Fuwai Hospital between 2010 and 2021. The variables were selected through least absolute shrinkage and selection operator regression (LASSO), and logistic regression models were constructed to identify independent risk factors. A total of 116 patients (52 males, median age at diagnosis, 25.0 years) were enrolled. Elevated blood pressure was the leading complaint. After a median follow-up period of 18.0 months (interquartile range: 6.0-48.0 months), hypertension recurred in 34 patients and restenosis in nine patients, among whom four patients underwent secondary intervention and one patient underwent surgical revascularization. Bilateral renal artery involvement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.11-6.15; p = 0.028) and age at hypertension onset (OR: 0.93, 95% CI: 0.88-0.99; p = 0.018) were independent prognostic factors for adverse outcomes. The results indicate that patients with bilateral renal artery involvement and younger age at hypertension onset are more likely to have poorer clinical outcomes after PTRA, and should be more closely monitored.
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Affiliation(s)
- Yi-Ting Lu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ze-Ming Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Di Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xin-Chang Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yan-Kun Yang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiong-Jing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: ; Tel.: +86-10-8839-2162
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Li K, Cui M, Zhang K, Liang K, Zhai S. Clinical characteristics and long-term outcomes of endovascular treatment of renal artery fibromuscular dysplasia with branch lesions. Pediatr Nephrol 2021; 36:3169-3180. [PMID: 33837846 DOI: 10.1007/s00467-021-05067-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Renal artery fibromuscular dysplasia (FMD) can cause arterial stenosis, dissection, and aneurysm of renal arteries. This study aimed to analyze the clinical characteristics and evaluate the long-term outcomes of renal branch artery FMD in children and adults. METHODS Sixty-one patients with renal artery FMD underwent endovascular treatment, including 23 children and 38 adults. They were divided into two groups, the main artery FMD group (n = 40, with severe stenosis located in the main renal artery) and the branch artery FMD group (n = 21, with only the branch lesions in unilateral or bilateral branch artery). The clinical characteristics and long-term outcomes of these pediatric and adult patients were evaluated. RESULTS The incidence of branch FMD was higher in children than in adults (P = 0.005). Thirteen children showed one or more branch artery involvements. Hypertension and headache were the most common symptoms. The branch aneurysm with coexisting stenosis was more common in patients with branch artery FMD. During the follow-up, blood pressure was normal in 8 patients and lowered in 11 patients in the branch FMD group. The patient's glomerular filtration was increased in 61 patients (P < 0.001). Four-year freedom from reintervention in 21 branch artery FMD patients was lower than that in 40 main artery FMD patients (P < 0.05). CONCLUSIONS A higher incidence of renal branch artery FMD was observed in children than in adults. Endovascular treatment with balloon angioplasty can be used for treating renal branch artery FMD.
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Affiliation(s)
- Kun Li
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, 7#Weiwu Road, Zhengzhou, Henan, 450003, China
| | - Mingzhe Cui
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, 7#Weiwu Road, Zhengzhou, Henan, 450003, China
| | - Kewei Zhang
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, 7#Weiwu Road, Zhengzhou, Henan, 450003, China
| | - Kai Liang
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, 7#Weiwu Road, Zhengzhou, Henan, 450003, China
| | - Shuiting Zhai
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, 7#Weiwu Road, Zhengzhou, Henan, 450003, China.
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Tian Y, Yuan B, Zhang N, Huang Z. Outcomes Following the Endovascular Treatment of Renal Artery Stenosis Caused by Fibromuscular Dysplasia: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 78:362-372. [PMID: 34543714 DOI: 10.1016/j.avsg.2021.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/31/2021] [Accepted: 06/24/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Renal artery revascularization has been performed to improve blood pressure control and to cure hypertension in patients with renal artery fibromuscular dysplasia (RAFMD). We herein conducted a systematic review and meta-analysis of studies assessing outcomes associated with the treatment of hypertensive RAFMD patients via endovascular angioplasty in order to offer an up-to-date overview of the relative costs and benefits of this approach to revascularization in RAFMD patients. METHODS We systematically searched the PubMed and Embase databases and the Cochrane Central Register for Controlled Trials to identify relevant studies published as of January 15, 2020. Key outcomes of interest in these studies included technical success, the incidence of perioperative complications, cure rates, and overall improvement rates. RESULTS In total, we identified 36 relevant studies of 1916 total repairs conducted in 1191 patients. Of these included studies, 33 were retrospective, while 3 were prospective. The overall technical success rate across these studies was 94.3%. Rates of total, major, and minor complications in these pooled studies were 12.9%, 4.6%, and 7.4%, respectively. Pooled rates of cured hypertension and improved hypertension following angioplasty, defined according to study-specific criteria, were 37.0% [95% CI: 27.0%-47.0%] and 80.0% [95% CI: 75.0% to 84.0%], respectively, although these rates varied highly among studies. Cure rates for studies used current clinical definitions for substantial variations across studies. Cure rates in studies using current definitions of cured hypertension (blood pressure <140/90 mm Hg without treatment) were just 18.1% following angioplasty. Cure rates fell markedly with increasing mean patient age (OR associated with an increase in mean age of 10 years: -0.24 [95% CI: -0.44 to -0.04, P = 0.019] and with mean known duration of hypertension (OR associated with an increase in mean hypertension duration of 5 years: -0.09 [95% CI: -0.12 to -0.05, P = 0.001]). CONCLUSIONS These findings suggest that endovascular treatment yielded moderate benefits to RAFMD patients, with substantial variation across studies. The blood pressure outcome was strongly influenced by patient age.
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Affiliation(s)
- Yu Tian
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Biao Yuan
- Department of Vascular Surgery, Beijing Chao Yang Hospital, Affiliate of Capital Medical University, Beijing, People's Republic of China.
| | - Ning Zhang
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
| | - Zhiyong Huang
- Department of Vascular Surgery, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
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Li K, Cui M, Zhang K, Liang K, Zhai S. Clinical Characteristics and Long-Term Outcomes of Endovascular Treatment of Renal Artery Fibromuscular Dysplasia With Branch Lesions. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Otaal PS, Batta A, Sahoo SK, Vijayvergiya R. Overcoming Diagnostic Dilemma and Optimizing Intervention with Optical Coherence Tomographic Guidance in an Angiographically Ambiguous Renal Artery Stenosis Due to Fibromuscular Dysplasia. Int Med Case Rep J 2021; 14:435-441. [PMID: 34234576 PMCID: PMC8254557 DOI: 10.2147/imcrj.s317869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
With the advent of endovascular therapy, conventional angiography has replaced histology as a diagnostic gold standard for fibromuscular dysplasia (FMD). However, angiographic findings are not precisely diagnostic in isolated focal renal artery stenosis (RAS) in FMD. Optical coherence tomography (OCT) imaging by reflecting in vivo histology may improve the diagnostic accuracy in such cases. Restenosis following balloon angioplasty of RAS in FMD occurs frequently and often requires optimized reintervention. However, the role of OCT in the diagnostic evaluation of focal RAS in FMD and in optimizing the intervention is not well studied. We present a young female with resistant secondary hypertension due to bilateral focal RAS on angiography. In the absence of an angiographic string of beads appearance, the diagnoses remained uncertain. However, OCT imaging diagnosed a multifocal disease with characteristic changes of fibro-medial dysplasia, akin to its histological description in the literature. The patient underwent bilateral balloon angioplasty with good angiographic results. After one year on follow-up, relapse of uncontrolled systemic hypertension occurred due to bilateral restenosis. Despite a satisfactory repeat balloon angioplasty of the left-sided re-stenotic lesion, a significant residual pressure gradient persisted. Usage of OCT guided oversized balloon and stent safely achieved good results with complete resolution of the pressure gradient. Right renal artery stenosis required balloon angioplasty alone. She had complete resolution of hypertension without any medications at six months of follow-up. In conclusion, OCT can supplement other diagnostic modalities in providing a proper diagnosis in an angiographically ambiguous focal RAS in FMD. A persistent residual pressure gradient across the lesion despite good angiographic results may be optimized with OCT guidance during the intervention.
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Affiliation(s)
- Parminder Singh Otaal
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saroj Kumar Sahoo
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Oribe S, Toyohara T, Mishima E, Suzuki T, Kikuchi K, Watanabe S, Morita Y, Ota H, Seiji K, Miyazaki M, Takase K, Abe T. Fibromuscular dysplasia with recurrence after "long-term" following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients. BMC Nephrol 2021; 22:187. [PMID: 34016044 PMCID: PMC8135181 DOI: 10.1186/s12882-021-02342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.
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Affiliation(s)
- Shuntaro Oribe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takafumi Toyohara
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Eikan Mishima
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Suzuki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Koichi Kikuchi
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shun Watanabe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Morita
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaaki Abe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan. .,Department of Clinical Biology and Hormonal Regulation, Tohoku University Graduate School of Medicine, 980-8574, Sendai, Japan.
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Zhao K, Obayemi J, Lim MAC, Wang G, Naji A. Ex-Vivo Repair of Complex Hilar Renal Artery Aneurysms and Auto-Transplantation of Solitary Kidney. Ann Vasc Surg 2021; 74:523.e9-523.e13. [PMID: 33831521 DOI: 10.1016/j.avsg.2021.01.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022]
Abstract
Renal artery aneurysms (RAA) are rare and challenging to repair. We present a case of a 48-year-old female with solitary right kidney who had complex aneurysms near the renal hilum. CT angiogram showed fibromuscular dysplasia (FMD) features of the renal artery and 2 saccular aneurysms measuring 2.3 cm and 1 cm. An additional small lower pole renal artery added to the complexity of the case. Ex-vivo aneurysm repair was performed after the kidney was removed and flushed with preservation solution. This was followed by auto-transplantation to the right external iliac vessels. The patient did well postoperatively without need for dialysis with serum creatinine returning to normal 5 weeks after.
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Affiliation(s)
- Kai Zhao
- Division of Transplant and Hepatobiliary Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | - Joy Obayemi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mary Ann C Lim
- Renal Division, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Grace Wang
- Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ali Naji
- Division of Transplant Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Abstract
Paediatric hypertension, defined as systolic blood pressure > 95th percentile for age, sex and height is often incidentally diagnosed. Renovascular hypertension (RVH) is responsible for 5-25% of hypertension in children. Renal artery stenosis and middle aortic syndrome can both can be associated with various conditions such as fibromuscular dysplasia, Williams syndrome & Neurofibromatosis type 1. This paper discusses the approaches to diagnosis and interventional management and outcomes of renovascular hypertension in children. Angiography is considered the gold standard in establishing the diagnosis of renovascular disease in children. Angioplasty is beneficial in the majority of patients and generally repeated angioplasty is considered more appropriate than stenting. Surgical options should first be considered before placing a stent unless there is an emergent requirement. Given the established safety and success of endovascular intervention, at most institutions it remains the preferred treatment option.
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Affiliation(s)
- Premal Amrishkumar Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Anne Marie Cahill
- Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Chen Y, Dong H, Jiang X, Deng Y, Zou Y, Che W, Xiong H, Xu B, Yang Y, Gao R. Percutaneous transluminal angioplasty with selective stenting for the treatment of renal artery stenosis caused by fibromuscular dysplasia: 18 years' experience from the China Center for Cardiovascular Disease. Catheter Cardiovasc Interv 2020; 95 Suppl 1:641-647. [PMID: 31943685 DOI: 10.1002/ccd.28679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to evaluate the safety and efficiency of percutaneous transluminal angioplasty (PTA) with selective stenting treating Chinese patients with renal artery stenosis (RAS) due to fibromuscular dysplasia (FMD). BACKGROUND Endovascular data of patients with RAS caused by FMD are scarce in China. METHODS Clinical data of 105 hypertensive patients with RAS caused by FMD underwent endovascular therapy at a single-site between June 2001 and October 2018 were analyzed retrospectively. Baseline blood pressure, use of antihypertensive medications, renal function, and adverse events at a 1-year follow-up were evaluated. RESULTS The patients were aged between 10 and 64 years (mean age 26.7 ± 8.2 years) and 52 (49.5%) were female. In total, 105 patients undergoing endovascular therapy involving 124 RASs. Thirty (24.2%), sixty-four (51.6%), and thirty (24.2%) RASs were multifocal, unifocal, and tubular types, respectively. Ninety-four (89.5%) and eleven (10.5%) patients underwent PTA alone and PTA plus stenting, respectively. The technical success rate for endovascular therapy was 95.2% (100/105) without severe complications. During 1-year follow-up (n = 100), the mean systolic and diastolic blood pressure decreased from 157.6 ± 17.5 and 102.3 ± 14.2 to 129.6 ± 12.3 and 81.3 ± 11.1 mmHg, respectively, and the number of antihypertensive medications reduced from 2.2 ± 1.2 to 0.8 ± 1.0 (all p < .001). The cure rate and improved rate of blood pressure was 49.0 and 40.0%, respectively. The serum creatinine levels remained stable. The primary and secondary restenosis rate was 13.4 and 5.8%, respectively. CONCLUSION Endovascular therapy for treating RAS caused by FMD was technically safe and effective for reducing blood pressure in Chinese patients.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiongjing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Deng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wuqiang Che
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Xiong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 1951] [Impact Index Per Article: 390.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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The Use of Antithrombotics Is Not Beneficial for Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery: A Meta-analysis. Ann Vasc Surg 2019; 60:415-423.e4. [DOI: 10.1016/j.avsg.2019.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/31/2019] [Accepted: 02/17/2019] [Indexed: 12/16/2022]
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15
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Al-Nouri O, Pan J, Mannava K. Endovascular Treatment of Concomitant Carotid Fibromuscular Dysplasia and Atherosclerotic Disease After Failed Open Surgical Treatment. Vasc Endovascular Surg 2019; 53:250-254. [PMID: 30866750 DOI: 10.1177/1538574418819299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe a case of concomitant fibromuscular dysplasia (FMD) and atherosclerotic internal carotid artery (ICA) disease in a symptomatic patient. Sixty-eight-year-old female presented for evaluation of a transient ischemic attack. Imaging revealed severe proximal >80% ICA stenosis with severe FMD to mid and distal ICA. Planned hybrid approach with left carotid endarterectomy (CEA) and balloon angioplasty was aborted intraoperatively due to lack of back bleeding. Open gradual rigid dilation was then performed with resumption of back bleeding. Completion angiogram revealed widely patent flow through CEA patch with no residual defects. Patient awoke from operation neurologically intact. At 6-month follow-up, carotid duplex revealed severe recurrent ICA stenosis. Endovascular intervention was performed with balloon dilation to the proximal and mid-ICA with stenting of a moderate 60% ostial common carotid stenosis. She recovered well from procedure with 3-month carotid duplex showing widely patent common carotid stent and ICA with no areas of stenosis. Informed consent has been obtained from the patient for publication of the case report and accompanying images.
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Affiliation(s)
- Omar Al-Nouri
- 1 Department of Surgery, Fairfield Medical Center, Lancaster, OH, USA
| | - James Pan
- 1 Department of Surgery, Fairfield Medical Center, Lancaster, OH, USA
| | - Krishna Mannava
- 1 Department of Surgery, Fairfield Medical Center, Lancaster, OH, USA
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16
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van Twist DJL, de Leeuw PW, Kroon AA. Renal artery fibromuscular dysplasia and its effect on the kidney. Hypertens Res 2018; 41:639-648. [DOI: 10.1038/s41440-018-0063-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
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17
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Tsioufis C, Andrikou I, Siasos G, Filis K, Tousoulis D. Anti-hypertensive treatment in peripheral artery disease. Curr Opin Pharmacol 2018; 39:35-42. [DOI: 10.1016/j.coph.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 12/30/2022]
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18
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Qureshi IA, Rodriguez GJ, Chacon-Quesada T, Jose GH, Cruz-Flores S, Maud A. Cervical Arterial Fibromuscular Dysplasia in a Biethnic Population: A Retrospective Study in the U.S.-Mexican Border. Int J Angiol 2017; 26:253-258. [PMID: 29142493 DOI: 10.1055/s-0036-1593773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background There have been studies trying to characterize Fibromuscular Dysplasia (FMD); however, most of them are based in mainly non-Hispanic sample. The objective of this study is to better understand the epidemiology and clinical characteristics of craniocervical FMD in the Hispanic population. Methods We retrospectively reviewed the cerebral angiograms performed in our center in a period of 3.5 years under any indication looking for angiographic patterns of FMD. Exclusion criteria consisted of cases in which the first angiogram was done when the patients were younger than 18 years. Patients were subdivided based on those with FMD and those without it for baseline characteristics and were looked for any associations. We further compared the same baseline characteristics among Hispanic FMD and non-Hispanic FMD population. A chart review was conducted looking for clinical features and vascular events. Results We analyzed 448 angiograms among patients younger than 18 years. We identified 47 patients with evidence of FMD involving the cervical arteries and 401 patients without FMD. Of the 47 patients with FMD in our neuroendovascular registry, we found that 76.6% were women and 57.4% were Hispanics. There was no statistical significant difference when comparing the variables across ethnicities, except history of cigarette smoking and dyslipidemia. The most common associated supra-aortic arterial lesions seen in the FMD group were intracranial aneurysm and arterial dissections. We then used same variables to compare Hispanic FMD with non-Hispanic FMD. We have found that there has been a positive association of cigarette smoking and dyslipidemia with FMD ( p ≤ 0.05). Conclusion Our study suggests that FMD affecting the carotid and vertebral arteries has similar demographic pattern across ethnicities in the United States. In Hispanics, the disease appears to have a predilection for women and history of cigarette smoking. Intracranial aneurysm and arterial dissection were the most commonly associated arterial lesions.
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Affiliation(s)
- Ihtesham A Qureshi
- Department of Neurology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Gustavo J Rodriguez
- Department of Neurology, Texas Tech University Health Sciences Center, El Paso, Texas
| | | | - Gavito-Higuera Jose
- Department of Radiology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center, El Paso, Texas
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 661] [Impact Index Per Article: 94.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Phukan C, George AJP, Chandrasingh J, Devasia A. Surgical revascularization of bilateral renal artery stenosis due to fibromuscular dysplasia. Urol Ann 2017; 9:188-191. [PMID: 28479775 PMCID: PMC5405667 DOI: 10.4103/ua.ua_102_16] [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] [Indexed: 11/05/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a noninflammatory disease affecting small- and medium-sized arteries of the renal and the carotids. It affects the renal arteries in nearly 60%–75% cases. The primary clinical manifestation of renal FMD is hypertension. Medial fibroplasia represents the most common dysplastic lesion. We report two cases who presented with hypertension and renal insufficiency and on evaluation was found to have bilateral renal artery stenosis. Stenting of the renal vessels was not possible due to the narrowed caliber of the vessel and inability to cannulate the renal arteries. They underwent renal artery revascularization with a splenorenal end to end anastomosis. The renal parameters and blood pressure of both the patients stabilized subsequently. Renal revascularization can be a good option for patient having failed angioplasty with stenting.
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Affiliation(s)
- Chandan Phukan
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arun J P George
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Chandrasingh
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Antony Devasia
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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21
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Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33:557-576. [PMID: 28449828 DOI: 10.1016/j.cjca.2017.03.005] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 01/29/2023] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Steven E Gryn
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Praveena Sivapalan
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Stroke, Heart and Stroke Foundation of Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Gregory Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Southern Medical Program, Kelowna, British Columbia, Canada
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janusz Kaczorowski
- Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- McMaster University, Hamilton Health Sciences Population Health Research Institute, Hamilton, Ontario, Canada
| | - Debra Reid
- Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais, Groupes de médecine de famille (GMF) de Wakefield, Wakefield, Quebec, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London and the St George's Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Ur BJ, Kaan J, Corriere MA. Renal Artery Stenosis: Recent Evidence, Evidence Gaps, and Practical Approaches to Diagnosis and Management. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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.
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Gungor M, Aparci M, Özer AC. Premature Atherosclerosis and Drug Eluting Stent Restenosis in an Adult with Osteogenesis Imperfecta. Int J Angiol 2016; 25:e166-e168. [PMID: 28031688 PMCID: PMC5186212 DOI: 10.1055/s-0036-1572363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Mild form of osteogenesis imperfecta (OI) may have a normal life span. However, cardiovascular complications including aortic and valvular heart disease, and coronary artery disease may complicate the life period. We presented a patient with mild form of OI and premature coronary atherosclerosis. He had been performed primary percutaneous angioplasty and drug eluting stent implantation to left anterior descending coronary artery osteal lesion. Then he presented with unstable angina pectoris due to the diffuse in-stent restenosis and a highly critical lesion adjacent to previously stented segment. He was suggested coronary artery bypass grafting (CABG), but he preferred coronary angioplasty and was implanted everolimus eluting stent. Control angiography, performed at 9th month, revealed the everolimus eluting stent was satisfactorily patent and the patient was asymptomatic. Numerous genetic defects and histopathological abnormalities of collagen and bone formation that were reported in the etiology of OI may be accounted for premature atherosclerosis in OI. Patients with mild form of OI may present with premature atherosclerosis and acute myocardial infarction. Everolimus eluting stent implantation may be a better choice of drug eluting stent in patients with OI instead of other drug eluting stent or minimally invasive CABG.
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Affiliation(s)
- Mutlu Gungor
- Department of Cardiology, Memorial Hospital, Istanbul, Turkey
| | - Mustafa Aparci
- Department of Cardiology, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ali C. Özer
- Department of Cardiology, Bayındır Hospital, Ankara, Turkey
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Lewis S, Kadian-Dodov D, Bansal A, Lookstein RA. Multimodality imaging of fibromuscular dysplasia. Abdom Radiol (NY) 2016; 41:2048-60. [PMID: 27216744 DOI: 10.1007/s00261-016-0778-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fibromuscular dysplasia (FMD) is an uncommon non-inflammatory and non-atherosclerotic cause of arterial disease that may result in stenosis, tortuosity, aneurysm, or dissection. The clinical presentation depends on the vascular bed involved and ranges from asymptomatic to multisystem disease and end organ ischemia. The purpose of this article is to review the role of imaging in patients with FMD with an emphasis on renal FMD. The relevant epidemiology, histopathology, imaging techniques, and interpretation of images will be discussed. CONCLUSION Renal artery FMD requires a high index of suspicion for accurate and prompt diagnosis and implementation of appropriate therapy. The treatment will vary based on clinical presentation and distribution of involvement. Noninvasive imaging with duplex ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are reasonable alternatives for the depiction of FMD in comparison to catheter-directed angiography (CA). Patients with FMD are often treated by multispecialty practice including the interventional radiologist.
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Affiliation(s)
- Sara Lewis
- Body Imaging Section, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA.
| | - Daniella Kadian-Dodov
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - A Bansal
- Body Imaging Section, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - R A Lookstein
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
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Edem E, Aksoy MN, Pabuccu MT, Tatlı E. Endovascular Treatment of Renal Artery Stenosis due to Fibromuscular Dysplasia - Is Stent Implantation Underused in this Circumstance? Heart Views 2016; 17:69-71. [PMID: 27512536 PMCID: PMC4966212 DOI: 10.4103/1995-705x.185118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic and noninflammatory arterial disease that commonly affects the renal and carotid arteries. The primary target in treating patients with renal artery FMD is the control of blood pressure in order to prevent end-organ damage, which can be caused by poorly controlled hypertension. Invasive endovascular treatment should be taken into consideration both when hypertension cannot be controlled with medication. According to current opinion, hypertension attributed to renal artery FMD is often successfully treated solely with percutaneous renal balloon angioplasty (PRBA), with no requirement for stent implantation under most circumstances. However, an FMD recurrence after PRBA occurs frequently in these patients.
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Affiliation(s)
- Efe Edem
- Department of Cardiology, Tınaztepe Hospital, Izmir, Turkey
| | - Murat Necati Aksoy
- Department of Cardiology, Sakarya University Training and Research Hospital, Izmir, Turkey
| | - Mustafa Türker Pabuccu
- Department of Cardiology, Sakarya University Training and Research Hospital, Izmir, Turkey
| | - Ersan Tatlı
- Department of Cardiology, Sakarya University Training and Research Hospital, Izmir, Turkey
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Incidence and risk factors for restenosis, and its impact on blood pressure control after percutaneous transluminal renal angioplasty in hypertensive patients with renal artery stenosis. J Hypertens 2016; 34:1407-15. [DOI: 10.1097/hjh.0000000000000928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Clinical characteristics and treatment of renal artery fibromuscular dysplasia with percutaneous transluminal angioplasty: a long-term follow-up study. Clin Res Cardiol 2016; 105:930-937. [PMID: 27270759 DOI: 10.1007/s00392-016-1001-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/27/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Renal artery fibromuscular dysplasia (RAFMD) is a non-atherosclerotic cause of renal artery stenosis often affecting the young. Percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice but there are few studies of the outcome of the procedure. METHODS This retrospective analysis included 64 patients (56.2 % female; mean age at diagnosis, 28.0 years) with RAFMD who underwent PTRA between November 2003 and August 2015. Technical and clinical success rates and restenosis rates were evaluated. RESULTS Seventy-six procedures were performed on 64 RAFMD patients. Technical success was 96.9 %, as defined by <30 % residual stenosis, with stent placement required in 11 patients (17.2 %). In the short term (1 month), the majority (79.7 %) had an immediate clinical benefit, with cure of hypertension in 35.9 %, and improvement in hypertension and a lower requirement for antihypertensive medications in 43.8 %. In the long term (mean, 47.5 months; range, 5-141 months), the survival rate was 96.9 %, freedom from restenosis was 84.4 %, and 76.6 % of patients showed a sustained clinical benefit (cure rate 40.6 %, improvement rate 35.9 %). Eight patients were treated with a second procedure and two had a third procedure, with half of these patients showing an improvement in hypertension. CONCLUSION PTRA for symptomatic RAFMD is safe and clinically successful. More than half of patients experience an immediate clinical benefit with sustained long-term effects. For patients with restenosis, there was a good response to a second PTRA.
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Green R, Gu X, Kline-Rogers E, Froehlich J, Mace P, Gray B, Katzen B, Olin J, Gornik HL, Cahill AM, Meyers KE. Differences between the pediatric and adult presentation of fibromuscular dysplasia: results from the US Registry. Pediatr Nephrol 2016; 31:641-50. [PMID: 26525198 DOI: 10.1007/s00467-015-3234-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fibromuscular dysplasia (FMD) is a non-inflammatory arteriopathy that causes significant morbidity in children. METHODS The clinical features, presenting symptoms, and vascular beds involved are reviewed in the first 33 patients aged <18 years who are enrolled in the United States Registry for FMD from five registry sites and compared with 999 adult patients from 12 registry sites. RESULTS Mean age at diagnosis was 8.4 ± 4.8 years (16 days to 17 years). Compared with adults, pediatric FMD occurs in more males (42.4 vs 6 %, p < 0.001). Children with FMD have a stronger previous history of hypertension (93.9 vs 69.9 %, p = 0.002). Hypertension (100 %), headache (55 %), and abdominal bruits (10.7 %) were the most common presenting signs and symptoms. FMD affects renal vasculature in almost all children (97 vs 69.7 %, p = 0.003). The extra-cranial carotid vessels are less commonly involved in children (23.1 vs 73.3 %, p < 0.001). The mesenteric arteries (38.9 vs 16.2 %, p = 0.02) and aorta (26.3 vs 2.4 %, p < 0.001) are more commonly involved in children. CONCLUSIONS In the United States Registry for FMD, pediatric FMD affects children from infancy throughout childhood. All children presented with hypertension and many presented with headache and abdominal bruits. In children, FMD most commonly affects the renal vasculature, but also frequently involves the mesenteric arteries and abdominal aorta; the carotid vessels are less frequently involved.
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Affiliation(s)
- Rebecca Green
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Division of General Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, 9NW63, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA.
| | - Xiaokui Gu
- University of Michigan, Ann Arbor, MI, USA
| | | | | | - Pamela Mace
- Fibromuscular Dysplasia Society of America, Rocky River, OH, USA
| | - Bruce Gray
- Greenville Health System, Greenville, SC, USA
| | - Barry Katzen
- Miami Baptist Cardiac/Vascular Institute, Miami, FL, USA
| | - Jeffrey Olin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ann Marie Cahill
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin E Meyers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Affiliation(s)
- Sarah C O'Connor
- Cleveland Clinic Lerner College of Medicine, Case Western University, Cleveland, OH
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Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory angiopathy of unknown cause affecting medium-sized (most commonly renal) arteries and causing renovascular hypertension. The most common medial multifocal type of FMD (with the “string of beads” appearance) is more than four times more prevalent in females than in males. FMD accounts for up to 10% of cases of renovascular hypertension. Compared with patients with atherosclerotic renal artery stenosis, patients with FMD are younger, have fewer risk factors for atherosclerosis, and a lower occurrence of atherosclerosis in other vessels. The etiology is multifactorial, including vessel wall ischemia and smoking, as well as hormonal and genetic factors. Intra-arterial digital subtraction angiography is still the gold standard for exclusion or confirmation of renal artery stenosis caused by FMD, at least in young patients, who more often have lesions in branches of the renal artery. For FMD patients with atherosclerosis and those who are older (>50–55 years), significant renal artery stenosis may be confirmed or excluded with ultrasonography. The FMD lesion is typically truncal or distal, whereas atherosclerotic lesions are more often proximal or ostial. Treatment options are medical, endovascular (percutaneous transluminal renal angioplasty [PTRA]), and surgical. Invasive treatment should be considered when hypertension cannot be controlled with antihypertensive drugs and in patients with impaired renal function or ischemic nephropathy. PTRA has become the treatment of choice and normally yields good results, especially in unifocal disease and young patients. Pressure gradients are normally completely abolished, and there is no indication for stent placement. Surgical revascularization is indicated after PTRA complications; thrombosis, perforation, progressive dissection, repeated PTRA failure or restenosis. Centralization of handling is recommended.
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Affiliation(s)
- Anders Gottsäter
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Bengt Lindblad
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
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Ham SW, Weaver FA. Ex vivo renal artery reconstruction for complex renal artery disease. J Vasc Surg 2014; 60:143-50. [DOI: 10.1016/j.jvs.2014.01.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
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Chrysant SG, Chrysant GS. Treatment of hypertension in patients with renal artery stenosis due to fibromuscular dysplasia of the renal arteries. Cardiovasc Diagn Ther 2014; 4:36-43. [PMID: 24649423 DOI: 10.3978/j.issn.2223-3652.2014.02.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/27/2014] [Indexed: 11/14/2022]
Abstract
Renal artery stenosis (RAS) from fibromuscular dysplasia (FMD) is an uncommon cause of hypertension that affects mostly women. FMD is a noninflammatory vascular disease that predominantly affects mainly the renal arteries, but can also affect arteries in other vascular territories. The most common type of FMD is the media fibroplasia with the characteristic "string of beads" appearance (80-90%), whereas the two other types, the "intimal" and "adventitial" FMD are much less common accounting for 10% and <5% of cases, respectively. The prevalence of FMD in the general population is not well known. Estimates are derived from screening kidney donors, with a prevalence of about 2.6%. Among patients with renovascular hypertension (RVH), its incidence is about 10%, whereas 80-90% of RVH is due to atherosclerotic renal artery stenosis (ARAS). The treatment of choice of hypertension due to FMD is percutaneous renal angioplasty (PTRA). In contrast, hypertension due to ARAS is not frequently responsive to PTRA. In order to achieve successful control of hypertension in patients with FMD, a combination of PTRA with drugs that block the renin-angiotensin-aldosterone system (RAAS) is often necessary. The purpose of this review was to search the literature for newer diagnostic methods and treatment of FMD. Therefore, a Medline search of the English literature of published papers between 2008 and December 2013 was performed. Of 58 papers reviewed, 19 pertinent papers were selected including, studies, reviews, registries and case reports. The information from these studies together with collateral literature will be discussed in this concise review.
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Affiliation(s)
- Steven G Chrysant
- 1 University of Oklahoma College of Medicine, 2 INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - George S Chrysant
- 1 University of Oklahoma College of Medicine, 2 INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
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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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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]
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Venturini M, Querques G, Margari S, Agostini G, Colombo M, Caldara R, Socci C, De Cobelli F, Del Maschio A. Renal artery stenosis due to fibromuscular dysplasia in a transplanted kidney from a deceased donor: a difficult diagnosis at color Doppler ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:116-120. [PMID: 23657871 DOI: 10.1002/jcu.22056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/14/2012] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
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. Fibromuscular dysplasia is a less frequent, nonatherosclerotic, vascular disease, inducing stenosis at the proximal/mid-distal part of the renal artery. We report the case of a 44-year-old woman, in whom serum creatinine concentration increased and arterial hypertension developed 3 months after renal transplantation. Color Doppler ultrasonography showed a low arterial resistance index and prolonged acceleration time in the interlobar arteries, and a significantly increased peak systolic velocity at the mid third of the renal artery, demonstrating hemodynamically significant stenosis. Percutaneous transluminal angioplasty allowed stenosis correction and was followed by creatinine concentration and arterial blood pressure normalization.
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Affiliation(s)
- M Venturini
- Department of Radiology, San Raffaele Scientific Research Institute, Milan, Italy
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Lenck S, Labeyrie MA, Saint-Maurice JP, Tarlov N, Houdart E. Diaphragms of the carotid and vertebral arteries: an under-diagnosed cause of ischaemic stroke. Eur J Neurol 2014; 21:586-93. [DOI: 10.1111/ene.12343] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 12/11/2013] [Indexed: 01/20/2023]
Affiliation(s)
- S. Lenck
- Department of Neuroradiology; Hôpital Lariboisière; Paris France
| | - M.-A. Labeyrie
- Department of Neuroradiology; Hôpital Lariboisière; Paris France
| | | | - N. Tarlov
- Department of Neuroradiology; Hôpital Lariboisière; Paris France
| | - E. Houdart
- Department of Neuroradiology; Hôpital Lariboisière; Paris France
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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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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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Blood pressure and renal function before and after percutaneous transluminal renal angioplasty in fibromuscular dysplasia. J Hypertens 2013; 31:1183-8. [DOI: 10.1097/hjh.0b013e32836044b2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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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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Renal angioplasty for treatment of hypertensive patients with fibromuscular dysplasia. No country for old men. J Hypertens 2013; 31:1091-3. [PMID: 23636016 DOI: 10.1097/hjh.0b013e32836163d9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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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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Bhamidipati CM, LaPar DJ, Stukenborg GJ, Lutz CJ, Tracci MC, Cherry KJ, Upchurch GR, Kern JA. Transcatheter arterial revascularization outcomes at vascular and general surgery teaching hospitals and nonteaching hospitals are comparable. J Vasc Surg 2012; 56:247-55.e2. [PMID: 22583853 DOI: 10.1016/j.jvs.2011.12.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/27/2011] [Accepted: 12/28/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcomes following transcatheter interventions at vascular and general surgery teaching hospitals (STH) are unknown. We examine whether surgery training programs influence clinically relevant outcomes after commonly performed endovascular procedures. METHODS Using an all-payer inpatient care database from 2008, we selected adults who underwent either endovascular carotid stenting, endografting of descending thoracic aortic aneurysm, endovascular abdominal aortic aneurysm repair, or peripheral arterial revascularization. Patients were stratified by procedures completed at Surgery Teaching (Participate in Accreditation Council for Graduate Medical Education [ACGME]-accredited vascular and general surgery programs), STH, or nonteaching hospitals (NTH). Hierarchical regression models assessed adverse outcomes and in-hospital mortality among groups. RESULTS Of the 175,698 records, 44% of the patients were treated at STH, while 56% underwent procedures at NTH. The adjusted odds ratio of any complication or mortality at STH and NTH were similar. Transfers, weekend admissions, and nonelective cases were higher at STH (P < .001, respectively). Paradoxically, STH treated fewer patients with more than three comorbidities compared with NTH (STH: 47% vs NTH: 53%; P < .001). Surgical teaching status did not lower the adjusted odds of mortality for any procedure. Moreover, the occurrence of any complication (adjusted odds ratios, 0.9; 95% confidence interval, .82-1.14; P = .69) and mortality (adjusted odds ratios, 0.9; 95% confidence interval, .74-1.22; P = .67) were equivalent between vascular and general STH. CONCLUSIONS Following commonly performed transcatheter vascular procedures, and despite more transfers, weekend admissions, and nonelective procedures completed at STH, complications, and mortality were comparable across centers.
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Affiliation(s)
- Castigliano M Bhamidipati
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
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Clopidogrel use before renal artery angioplasty with/without stent placement resulted in tertiary procedure risk reduction. J Vasc Surg 2012; 56:416-23. [PMID: 22560231 DOI: 10.1016/j.jvs.2012.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/12/2011] [Accepted: 01/06/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Contrary to coronary artery literature, the effect of preprocedural clopidogrel on renal artery restenosis (RAR) has not been characterized. This study was designed to evaluate the effect of preprocedural clopidogrel on target vessel revascularization (TVR), reintervention, and restenosis for patients who underwent recurrent renal artery angioplasty. METHODS A retrospective analysis of patients treated for RAR in a single tertiary center from January 1999 to December 2009 was conducted. Patients were divided into preadmission use of (1) clopidogrel or (2) aspirin only (acetylsalicylic acid [ASA]) for the initial procedure. TVR was defined as occurrence of a tertiary procedure for symptomatic RAR. Rate of freedom from event (ie, tertiary restenosis and TVR) was analyzed using Kaplan-Meier method. RESULTS Eighty-eight interventions were performed on 77 patients with RAR; 66% were females with average (mean ± SEM) age and body mass index of 68.8 ± 1.1 and 28.6 ± 0.8, respectively. Comorbidities included 96% chronic hypertension, 33% diabetes, 76% hyperlipidemia, 20% renal insufficiency, 39% tobacco use, 58% coronary artery disease, and 51% peripheral vascular disease. Clopidogrel use increased significantly during the index procedure from admission 35.2% to discharge 97.7% (P < .001, McNemar test). There was a trend toward risk reduction of a tertiary intervention (23%) for patients admitted on clopidogrel compared with ASA (P = .052). Likewise, there was a trend (P = .051) toward increased freedom from a tertiary intervention, with cumulative freedom at 8 years 93.5% for clopidogrel vs 61% for ASA. No differences were found for restenosis. CONCLUSIONS The use of preprocedural clopidogrel was associated with a possible risk reduction of TVR reintervention, but this finding needs to be validated in randomized clinical trial.
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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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