Journal ArticleDOI
Renal Artery Stenosis.
TLDR
The goals for treating patients with RAS are to reduce cardiovascu-lar morbidity and mortality attributable to elevated arterial pressure and to preserve renal function beyond critical stenosis and to identify progressive occlusive disease and to determine appropriate timing for vascular intervention.Abstract:
Renal artery stenosis (RAS) can accelerate or generate progressive hypertension and renal dysfunction. The goals for treating patients with RAS are to reduce cardiovascu-lar morbidity and mortality attributable to elevated arterial pressure and to preserve renal function beyond critical stenosis. Recent, randomized trials with current anti-hypertensive agents indicate that many patients with RAS can be managed for years without renal artery revascularization. As it does elsewhere, atherosclerotic disease can progress to more severe occlusion in the renal arteries. Rapid advances in endo-vascular techniques, including stenting, make restoration of renal blood flow possible in more patients than before. Therapeutic goals are achieved by 1) avoidance of tobacco, 2) reducing arterial pressure with antihypertensive drug therapy, particularly those agents capable of blocking the renin-angiotensin system, and 3) renal revascu-larization, using balloon angioplasty and stent placement, surgical bypass, or endart-erectomy. The major clinical challenges are to identify progressive occlusive disease and to determine appropriate timing for vascular intervention.read more
Citations
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Journal ArticleDOI
Renovascular Hypertension and Ischemic Nephropathy
TL;DR: It is argued that revascularization offers the potential to improve or reverse renovascular hypertension, to salvage or preserve the renal circulation and renal function, and to improve the management of patients with refractory forms of congestive heart failure.
Journal ArticleDOI
Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure
TL;DR: Renal artery stenting decreased the frequency of congestive heart failure, flash pulmonary edema, and the need for hospitalization in most patients, and blood pressure was markedly improved in the majority of patients with improved or stabilized renal function.
Journal ArticleDOI
2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)
Victor Aboyans,Jean-Baptiste Ricco,Marie-Louise Bartelink,Martin Björck,Marianne Brodmann,Tina Cohnert,Jean-Philippe Collet,Martin Czerny,Marco De Carlo,Sebastian Debusa,Christine Espinola-Klein,Thomas Kahan,Serge Kownator,Lucia Mazzolai,A Ross Naylora,Marco Roffi,Joachim Rotherb,Muriel Sprynger,Michal Tendera,Gunnar Tepe,Maarit Venermoa,Charalambos Vlachopoulos,Ileana Desormais +22 more
TL;DR: 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).
Journal ArticleDOI
Antioxidant Intervention Blunts Renal Injury in Experimental Renovascular Disease
Alejandro R. Chade,Martin Rodriguez-Porcel,Joerg Herrmann,Xiangyang Zhu,Joseph P. Grande,Claudio Napoli,Amir Lerman,Lilach O. Lerman +7 more
TL;DR: Chronic antioxidant intervention in early experimental RVD improved renal functional responses, enhanced tissue remodeling, and decreased structural injury and suggests a role for antioxidant strategies in preserving the atherosclerotic and ischemic kidney.
Journal ArticleDOI
A prospective comparison of duplex ultrasonography, captopril renography, MRA, and CTA in assessing renal artery stenosis.
Hampus Eklöf,Håkan Ahlström,Ann christin Magnusson,Lars-Göran Andersson,Bertil Andrén,Anders Hägg,David Bergqvist,Rickard Nyman +7 more
TL;DR: MRA and CTA were significantly better than duplex ultrasonography and captopril renography in detecting hemodynamically significant RAS and cannot be recommended for assessing RAS.
References
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Journal ArticleDOI
Effects of an angiotensin-converting -enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients
TL;DR: Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.
Journal Article
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure
Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-53.
TL;DR: The study was designed to continue for 5 years, but it was stopped early because of the beneficial effects of ramipril on the primary outcome, as compared with 17.8% in the placebo group.
Journal ArticleDOI
The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis
Brigit C. Van Jaarsveld,Pieta Krijnen,Herman Pieterman,Frans H.M. Derkx,Jaap Deinum,Cornelis T. Postma,Ad Dees,Arend J.J. Woittiez,A. K. M. Bartelink,Arie J. Man in 't Veld,Maarten A.D.H. Schalekamp +10 more
TL;DR: In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy.
Journal ArticleDOI
Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial
Peter J.G. van de Ven,R. Kaatee,Jaap J. Beutler,Frederick Ja Beek,A J Woittiez,Erik Buskens,Hein A. Koomans,Willem P.Th.M. Mali +7 more
TL;DR: PTAS is a better technique than PTA to achieve vessel patency in ostial atherosclerotic renal-artery stenosis, however, the burden of reintervention after PTA outweighs the potential saving in stents, so primary PTAS is the better approach to use.