Volume - Issue - February 2011

Renal Artery Stenosis in 2011

Christopher J. Cooper, MD and William R. Colyer, Jr., MD

In this issue of Vascular Disease Management we have a unique opportunity to obtain a global perspective on the management of renal artery stenosis. Certainly in the United States and Europe, management of atherosclerotic renal artery stenosis is an important issue for our aging populations and overburdened healthcare systems.

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Key words:

ASTRAL and Beyond: Who is Appropriate to Consider for Renal Artery Revascularization?

James Ritchie, MRCP and Philip A. Kalra, MD, FRCP

ABSTRACT: ASTRAL and the four randomized, controlled trials preceding have shown that unselected revascularization in atherosclerotic renovascular disease (ARVD) is not an appropriate intervention. Despite this, there are clinical situations where renal artery revascularization is of great benefit to the patient. In this review we discuss the different presentations of ARVD and the effects of revascularization for each.

VASCULAR DISEASE MANAGEMENT 2011;8:E12–E20

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Renal Artery Intervention — Endovascular Techniques

Thomas Zeller, MD, Aljoscha Rastan, MD, Elias Noory, MD

ABSTRACT:Significant renal artery stenosis (RAS) may result in deterioration of arterial hypertension and/or renal insufficiency and may contribute to cardiovascular diseases such as diastolic and systolic heart failure. Percutaneous transluminal angioplasty (PTA) is the established therapy for RAS of fibromuscular disease origin. The role of cutting balloon angioplasty in this indication still needs to be investigated. In atherosclerotic RAS, stenting has shown superior acute and long-term technical outcomes compared to PTA.

continue reading
Key words:

Life After ASTRAL: Who Should Be Revascularized for Renal Artery Stenosis?

Amit Prasad, MD and Christopher J. White, MD

Introduction

Hemodynamically significant renal artery stenosis (RAS) induces hypoperfusion of the affected kidney leading to a constellation of physiologic responses.1 Upregulation of the renin-angiotensin-aldosterone system (RAAS) results in arterial vasoconstriction, impaired natriuresis, and fluid retention.2 Over time, hypoperfusion can lead to renal atrophy and fibrosis.3 Renal artery revascularization can restore perfusion to ischemic kidneys and prevent further injury.4

continue reading
Key words:

Improving Interpretation of MRA and CTA in Patients with Suspected Renal Artery Stenosis

Honglei Zhang, MD, PhD, FACR and Martin R. Prince, MD, PhD

ABSTRACT:Contrast-enhanced computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are widely used in patients with suspected renal artery stenosis as screening techniques. Both are accurate in depicting anatomical changes of renal vasculature. However, when interpreting MRA/CTA, additional functional information including asymmetrical size, post-stenotic dilatation and asymmetric enhancement may help determine the hemodynamic significance of renal artery stenoses, thus improving the interpretation and accuracy of renal MRA/CTA.

continue reading
Key words:

Stenting for Renal Artery Stenosis and CMS Reimbursement: An Interview with Matthew Edwards, MD and Steven Textor, MD

William R. Colyer, Jr., MD

One of the challenges facing medicine today is how to best allocate resources. As medical costs continue to rise, agencies such as the Centers for Medicare & Medicaid Services (CMS) must ensure that money is spent in a responsible manner. This requirement has resulted in the development of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). MEDCAC was established to provide “independent guidance and expert advice” to the CMS on various topics. MEDCAC evaluates strength of evidence and makes recommendations to the CMS based upon the evidence.

continue reading
Key words:

HIV Vasculopathy of the Renal Artery Manifesting as Severe Hypertension in a Young Female: Case Report and Review

Debbie Nel, MBChB and Brian Rayner, MBChB, FCP MMed

ABSTRACT: The burden of HIV infection, particularly in Sub-Saharan Africa, is well documented. The consequences are far-reaching and go beyond those of opportunistic infection and malignancy and into the realm of chronic diseases of lifestyle, with an increasing risk of cardiovascular disease in HIV-positive individuals.

continue reading
Key words:

Endovascular Treatment of a Renal Artery Aneurysm with Distal Stenosis: A Case Report and Review

Marcelo A. Agüero, MD, Pablo D. Liva, MD, Jorge A. Baccaro, MD

ABSTRACT: Renal artery aneurysms (RAAs) are being diagnosed with increasing frequency. They can be incidental or symptomatic. Rupture is the most feared complication. RAAs can be managed conservatively or treated with either surgery or an endovascular approach. We present the case of a 48-year-old female who had a large RAA with a distal stenosis that was treated with a stent-graft. Two-year follow-up is available on this patient. A review of the literature is also presented.

VASCULAR DISEASE MANAGEMENT 2011;8:E45–E49

continue reading
Key words:
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Volume - Issue - February 2011

Renal Artery Stenosis in 2011

Christopher J. Cooper, MD and William R. Colyer, Jr., MD

In this issue of Vascular Disease Management we have a unique opportunity to obtain a global perspective on the management of renal artery stenosis. Certainly in the United States and Europe, management of atherosclerotic renal artery stenosis is an important issue for our aging populations and overburdened healthcare systems.

continue reading
Key words:

ASTRAL and Beyond: Who is Appropriate to Consider for Renal Artery Revascularization?

James Ritchie, MRCP and Philip A. Kalra, MD, FRCP

ABSTRACT: ASTRAL and the four randomized, controlled trials preceding have shown that unselected revascularization in atherosclerotic renovascular disease (ARVD) is not an appropriate intervention. Despite this, there are clinical situations where renal artery revascularization is of great benefit to the patient. In this review we discuss the different presentations of ARVD and the effects of revascularization for each.

VASCULAR DISEASE MANAGEMENT 2011;8:E12–E20

continue reading
Key words:

Renal Artery Intervention — Endovascular Techniques

Thomas Zeller, MD, Aljoscha Rastan, MD, Elias Noory, MD

ABSTRACT:Significant renal artery stenosis (RAS) may result in deterioration of arterial hypertension and/or renal insufficiency and may contribute to cardiovascular diseases such as diastolic and systolic heart failure. Percutaneous transluminal angioplasty (PTA) is the established therapy for RAS of fibromuscular disease origin. The role of cutting balloon angioplasty in this indication still needs to be investigated. In atherosclerotic RAS, stenting has shown superior acute and long-term technical outcomes compared to PTA.

continue reading
Key words:

Life After ASTRAL: Who Should Be Revascularized for Renal Artery Stenosis?

Amit Prasad, MD and Christopher J. White, MD

Introduction

Hemodynamically significant renal artery stenosis (RAS) induces hypoperfusion of the affected kidney leading to a constellation of physiologic responses.1 Upregulation of the renin-angiotensin-aldosterone system (RAAS) results in arterial vasoconstriction, impaired natriuresis, and fluid retention.2 Over time, hypoperfusion can lead to renal atrophy and fibrosis.3 Renal artery revascularization can restore perfusion to ischemic kidneys and prevent further injury.4

continue reading
Key words:

Improving Interpretation of MRA and CTA in Patients with Suspected Renal Artery Stenosis

Honglei Zhang, MD, PhD, FACR and Martin R. Prince, MD, PhD

ABSTRACT:Contrast-enhanced computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are widely used in patients with suspected renal artery stenosis as screening techniques. Both are accurate in depicting anatomical changes of renal vasculature. However, when interpreting MRA/CTA, additional functional information including asymmetrical size, post-stenotic dilatation and asymmetric enhancement may help determine the hemodynamic significance of renal artery stenoses, thus improving the interpretation and accuracy of renal MRA/CTA.

continue reading
Key words:

Stenting for Renal Artery Stenosis and CMS Reimbursement: An Interview with Matthew Edwards, MD and Steven Textor, MD

William R. Colyer, Jr., MD

One of the challenges facing medicine today is how to best allocate resources. As medical costs continue to rise, agencies such as the Centers for Medicare & Medicaid Services (CMS) must ensure that money is spent in a responsible manner. This requirement has resulted in the development of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). MEDCAC was established to provide “independent guidance and expert advice” to the CMS on various topics. MEDCAC evaluates strength of evidence and makes recommendations to the CMS based upon the evidence.

continue reading
Key words:

HIV Vasculopathy of the Renal Artery Manifesting as Severe Hypertension in a Young Female: Case Report and Review

Debbie Nel, MBChB and Brian Rayner, MBChB, FCP MMed

ABSTRACT: The burden of HIV infection, particularly in Sub-Saharan Africa, is well documented. The consequences are far-reaching and go beyond those of opportunistic infection and malignancy and into the realm of chronic diseases of lifestyle, with an increasing risk of cardiovascular disease in HIV-positive individuals.

continue reading
Key words:

Endovascular Treatment of a Renal Artery Aneurysm with Distal Stenosis: A Case Report and Review

Marcelo A. Agüero, MD, Pablo D. Liva, MD, Jorge A. Baccaro, MD

ABSTRACT: Renal artery aneurysms (RAAs) are being diagnosed with increasing frequency. They can be incidental or symptomatic. Rupture is the most feared complication. RAAs can be managed conservatively or treated with either surgery or an endovascular approach. We present the case of a 48-year-old female who had a large RAA with a distal stenosis that was treated with a stent-graft. Two-year follow-up is available on this patient. A review of the literature is also presented.

VASCULAR DISEASE MANAGEMENT 2011;8:E45–E49

continue reading
Key words:
Back to top