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Wu HHL, Damle A, Chinnadurai R, Chrysochou C. Lessons for the clinical nephrologist: fibromuscular dysplasia in older adults. J Nephrol 2024:10.1007/s40620-024-02039-x. [PMID: 39090388 DOI: 10.1007/s40620-024-02039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Henry H L Wu
- Renal Research Laboratory, Level 9, Kolling Building, Kolling Institute of Medical Research, Royal North Shore Hospital and The University of Sydney, St. Leonards Sydney, Sydney, NSW, 2065, Australia.
| | - Avanti Damle
- Donal O'Donoghue Renal Research Centre and Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Donal O'Donoghue Renal Research Centre and Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Constantina Chrysochou
- Donal O'Donoghue Renal Research Centre and Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Kim HS, Na Choi SJ, Lee HK. Successful Kidney Transplantation Using a Deceased Donor Graft With Fibromuscular Dysplasia. Transplant Proc 2019; 51:2842-2844. [PMID: 31526531 DOI: 10.1016/j.transproceed.2019.02.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/06/2019] [Indexed: 11/19/2022]
Abstract
All over the world there is serious concern about the shortage of organs available for transplantation. In an effort to address this, transplantation with grafts, which was previously considered a contraindication, are now performed. In some cases, this practice has contributed to increasing the organ pool. Fibromuscular dysplasia (FMD) is the second-most-common cause of renovascular hypertension and is observed in 2%-6.6% of potential live kidney donors. Kidney with FMD is generally considered to be a contraindication for renal transplantation because renal artery stenosis may progress after transplantation and cause graft loss. Here, we report on a successful case of kidney transplantation using a graft with FMD of a deceased donor who had multiple aneurysms in the renal artery.
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Affiliation(s)
- Hyo-Sin Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Jin Na Choi
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
| | - Ho Kyun Lee
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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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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Kim W, Gandhi RT, Peña CS, Tartaglione RE, Taubman ML, Katzen BT. Robotic system-assisted endovascular treatment of a dissection-related pseudoaneurysm of the celiac axis secondary to fibromuscular dysplasia. J Vasc Surg Cases Innov Tech 2016; 2:145-148. [PMID: 38827192 PMCID: PMC11140368 DOI: 10.1016/j.jvscit.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022] Open
Abstract
Spontaneous celiac artery dissection caused by fibromuscular dysplasia is rare. Subsequent thrombosis and occlusion of the celiac trunk can result in intestinal ischemia and hepatic failure. We describe a case of spontaneous celiac artery dissection with an associated pseudoaneurysm caused by fibromuscular dysplasia, extending into the common hepatic artery. An endovascular intervention featuring robotic-assisted celiac artery cannulation with stent-assisted coil embolization resulted in successful treatment.
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Affiliation(s)
- Wonho Kim
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
- Herbert Wertheim College of Medicine, Florida International University, Miami, Fla
| | - Ripal T. Gandhi
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Constantino S. Peña
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Robert E. Tartaglione
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Michele L. Taubman
- Division of Vascular Surgery, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Barry T. Katzen
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
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6
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Weinberg I, Gu X, Giri J, Kim SE, Bacharach MJ, Gray BH, Katzen BT, Matsumoto AH, Chi YW, Rogers KR, Froehlich J, Olin JW, Gornik HL, Jaff MR. Anti-platelet and anti-hypertension medication use in patients with fibromuscular dysplasia: Results from the United States Registry for Fibromuscular Dysplasia. Vasc Med 2015; 20:447-53. [PMID: 25964292 DOI: 10.1177/1358863x15584982] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibromuscular dysplasia (FMD), a non-inflammatory arterial disease, may lead to renovascular hypertension (HTN) and cerebrovascular disease. Little is known about medication use in FMD. Clinical features and medication use were reviewed in a national FMD registry (12 US sites). Medication usage was assessed in raw and adjusted analyses. Covariates included demographic characteristics, co-morbid conditions and vascular bed involvement. A total of 874 subjects (93.6% female) were included in the analysis. Mean age was 55.6±13.1 years, 74.5% had HTN, 25.4% had a history of transient ischemic attack or stroke, and 7.5% had a history of coronary artery disease (CAD). Renal and cerebrovascular arteries were affected in 70.4% and 74.7%, respectively. Anti-platelet agents were administered to 72.9% of patients. In multivariate analyses, factors associated with a greater likelihood of anti-platelet agent use were older age (OR=1.02 per year, p=0.005), CAD (OR=3.76, p=0.015), cerebrovascular artery FMD involvement in isolation (OR=2.31, p<0.0001) or a history of previous intervention for FMD (OR=1.52, p=0.036). A greater number of anti-HTN medications was evident in isolated renal versus isolated cerebrovascular FMD patients. Factors associated with a greater number of anti-HTN medications were older age (OR=1.03 per year, p<0.0001), history of HTN (OR=24.04, p<0.0001), history of CAD (OR=2.71, p=0.0008) and a history of a previous therapeutic procedure (OR=1.72, p=0.001). In conclusion, in FMD, medication use varies based on vascular bed involvement. Isolated renal FMD patients receive more anti-HTN agents and there is greater anti-platelet agent use among patients with cerebrovascular FMD. Further studies correlating medication use in FMD with clinically meaningful patient outcomes are necessary.
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Affiliation(s)
- Ido Weinberg
- The Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaokui Gu
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Jay Giri
- Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Soo E Kim
- Cleveland Clinic Heart and Vascular Institute and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Bruce H Gray
- University of South Carolina School of Medicine/Greenville, Greenville, SC, USA
| | | | - Alan H Matsumoto
- Department of Radiology, Division of Vascular Interventional Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Yung-Wei Chi
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Kevin R Rogers
- Cardiology Division, University of Colorado, Denver, CO, USA
| | - James Froehlich
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-José and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
| | - Heather L Gornik
- Cleveland Clinic Heart and Vascular Institute and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Michael R Jaff
- The Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA
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7
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Outcomes of Hypertensive Patients with Renal Fibromuscular Dysplasia Compared with Patients with Concomitant Atherosclerotic Renal Artery Stenosis following Endovascular Therapy. J Vasc Interv Radiol 2015; 26:625-33; quiz 634. [DOI: 10.1016/j.jvir.2015.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/18/2015] [Accepted: 01/26/2015] [Indexed: 11/21/2022] Open
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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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Kumar N, Calhoun DA, Dudenbostel T. Management of patients with resistant hypertension: current treatment options. Integr Blood Press Control 2013; 6:139-51. [PMID: 24231917 PMCID: PMC3826290 DOI: 10.2147/ibpc.s33984] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Resistant hypertension (RHTN) is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new options to treat RHTN.
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Affiliation(s)
- Nilay Kumar
- Department of Medicine, Hypertension and Vascular Biology Program, University of Alabama at Birmingham, Birmingham, AL, USA
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Renal artery fibromuscular dysplasia in 2,640 renal donor subjects: a CT angiography analysis. J Vasc Interv Radiol 2013; 24:1477-80. [PMID: 23911200 DOI: 10.1016/j.jvir.2013.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 06/03/2013] [Accepted: 06/03/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To present the incidence, demographics, and clinical presentation of patients diagnosed with renal fibromuscular dysplasia (FMD) who underwent computed tomography (CT) angiography for evaluation of living renal donor protocol. METHODS AND MATERIALS A retrospective review was performed from January 1, 2000, to December 31, 2011 on patients who underwent CT angiography for evaluation of living renal donor protocol. Of 2,640 patients identified, only patients with a diagnosis of FMD by the radiology report underwent independent reader evaluation of CT angiography for the presence of FMD and associated characteristics. The demographics, medical history, and presentation were reviewed using the electronic medical chart. RESULTS The independent readers who evaluated CT angiography identified a diagnosis of FMD in 68 patients (2.6%; 59 female) with an average age of 52 years ± 10. Unilateral FMD was observed in 46 patients (68%), and bilateral FMD was observed in 22 patients (32%). Three patients had aneurysms of the renal artery. Comorbidities included hypertension (n = 21, 31%), dyslipidemia, (n = 13, 19%), history of migraines (n = 3, 4%), and history of smoking (n = 14, 21%). No patients had diabetes mellitus, coronary artery disease, or family history of FMD. Of 21 patients (31%) with a history of hypertension, 13 patients (62%) were treated with antihypertensive medications. CONCLUSIONS The incidence of FMD in patients who underwent CT angiography for evaluation of living renal donor protocol is 2.6%.
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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: 345] [Impact Index Per Article: 28.8] [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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Management of heart failure with renal artery ischemia. Cardiol Clin 2011; 29:433-45. [PMID: 21803231 DOI: 10.1016/j.ccl.2011.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With improved treatment, patients are surviving longer with impaired ventricular function. Hypertension results in ventricular remodeling in many patients. More than 5 million people have heart failure and are likely to have one or more co-existent diseases associated with aging, one of which is chronic kidney disease (CKD). Renal artery stenosis is fraught with varying opinions. Nephrologists, cardiologists, and interventional radiologists all manage these diseases with different strategies. This article outlines renovascular disease as it relates to CKD, the pathophysiology of development of renovascular disease and effects leading to congestive heart failure, treatment modalities, and outcomes of treatment regimens.
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Olin JW, Sealove BA. Diagnosis, management, and future developments of fibromuscular dysplasia. J Vasc Surg 2011; 53:826-36.e1. [DOI: 10.1016/j.jvs.2010.10.066] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 10/07/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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Prasad A, Zafar N, Mahmud E. Assessment of renal artery fibromuscular dysplasia: angiography, intravascular ultrasound (with virtual histology), and pressure wire measurements. Catheter Cardiovasc Interv 2009; 74:260-4. [PMID: 19213069 DOI: 10.1002/ccd.21968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fibromuscular dysplasia (FMD) of the renal arteries is classically associated with secondary hypertension in younger individuals, which may be treatable and even curable by percutaneous transluminal renal angioplasty. Angiography of these renal arteries often displays "beaded" luminal abnormalities. The angiographic findings, however, may not accurately reflect the severity or precise location of the intraluminal obstruction. We present a case of an older individual with longstanding hypertension and FMD, in whom the use of a coronary pressure wire and intravascular ultrasound enabled precise localization and treatment of the hemodynamically significant stenosis. Virtual histology of FMD in the renal vasculature is also reported.
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Affiliation(s)
- Anand Prasad
- Division of Cardiovascular Medicine, University of California, San Diego, CA 92103-8784, USA
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Thatipelli M, Huettl E, McKusick M, Misra S. Angioplasty for Renal Artery Fibromuscular Dysplasia in Older Hypertensive Patients. Angiology 2009; 60:714-8. [DOI: 10.1177/0003319709335512] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To describe the outcomes of treating patients with angioplasty who are older than 40 years with symptomatic/labile/refractory hypertension (HTN). Methods: Between1999 and 2005, 28 patients underwent angioplasty for renal fibromuscular dysplasia (FMD). Patients were excluded if they had concomitant atherosclerotic renal artery stenosis (n = 4) or less than 1 month follow-up (n = 8). Results: The study group included 16 Caucasians (21 procedures; mean age 65.5 10.8 years; females = 88%). The cardiovascular risk factors include HTN (n = 13), smoking (n = 1), diabetes (n = 2), dyslipidemia (n = 8). The HTN was characterized as refractory (n = 15, 12 were symptomatic) and new-onset in 1 patient. The technical success rate was 100%. Over a median period of 12.8 months (range: 1.0-85.8), 18 (95%) procedures ‘‘failed,’’ of which 8 (42%) within 1 month and the rest in 1 year. Conclusions: Angioplasty in symptomatic renal FMD in patients >40 years is associated with poor outcomes possibly due to early restenosis.
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Affiliation(s)
| | - E.A. Huettl
- Department of Vascular & Interventional, Radiology Rochester, Minnesota
| | - M.A. McKusick
- Department of Vascular & Interventional Radiology, Rochester, Minnesota
| | - S. Misra
- Department of Vascular & Interventional Radiology, Rochester, Minnesota,
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Abstract
With improved treatment, patients are surviving longer with impaired ventricular function. Hypertension results in ventricular remodeling in many patients. More than 5 million people have heart failure and are likely to have one or more co-existent diseases associated with aging, one of which is chronic kidney disease (CKD). Renal artery stenosis is fraught with varying opinions. Nephrologists, cardiologists, and interventional radiologists all manage these diseases with different strategies. This article outlines renovascular disease as it relates to CKD, the pathophysiology of development of renovascular disease and effects leading to congestive heart failure, treatment modalities, and outcomes of treatment regimens.
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Affiliation(s)
- Madhav V Rao
- Section of Nephrology, Department of Internal Medicine, University of Chicago, Chicago, IL 60637, USA.
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18
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Abstract
Atherosclerotic renovascular disease (ARVD) accounts for >90% of renal artery stenosis (RAS) in Western populations; the remainder are due to fibromuscular disease (FMD). The epidemiology is quite different in the Indian subcontinent and the Far East where Takayasu's arteritis may be responsible for up to 60% of RAS cases. ARVD is very commonly associated with hypertension and renal dysfunction; it is a disease of ageing and is frequently observed in association with other vascular diseases. There is increasing evidence that in patients with ARVD and chronic renal dysfunction the aetiology of the latter is more often due to long-standing intra-renal vascular disease and parenchymal injury than to reversible ischaemia. This is reflected in the variability in renal functional outcome following revascularization, with an improvement in renal function being observed in only a minority of patients; the majority show no apparent change or even a decline in renal function. A major current challenge concerns the identification of patients who are likely to benefit from renal revascularization procedures, but technological advances in imaging offer potential in aiding this selection. Large-scale randomized controlled trials are required to determine the overall effects of renal artery intervention and, more specifically, to help identify which subgroups of patients will benefit from revascularization.
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Affiliation(s)
- Ching M Cheung
- Department of Renal Medicine, Hope Hospital, Salford M6 8HD, UK
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