POS-411 REFRACTORY HYPERTENSION AND RENAL ARTERY STENOSIS DURING PREGNANCY: A THERAPEUTIC DILEMMA

Purpose: To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S). Methods: The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death. Results: Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year. Conclusions: PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.

Download Full-text

Refractory hypertension secondary to renal artery stenosis with a honeycomb-like structure

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02428-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheng Chen ◽

Ying Zhang ◽

Da Yin ◽

Yan Liu ◽

Yunpeng Cheng ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Fibrous Tissue ◽

Honeycomb Structure ◽

Artery Stenosis ◽

Proximal Segment ◽

Left Renal Artery ◽

Renal Infarction ◽

Refractory Hypertension ◽

Spider Web

Abstract Background A honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like ‘swiss cheese’, a ‘spider web’ or a ‘lotus root’. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. More information about the characteristics and development of HLS is needed. Case presentation A 69-year-old Han man with resistant hypertension received abdominal enhanced computerised tomography and was revealed to have left renal artery stenosis with the possibility of left renal infarction. Renal artery angiography confirmed a 95% stenosis located in the proximal segment of the left renal artery, and the middle segment was blurred with multi-channel-like blood flow. Further IVUS was performed and identified multiple channels surrounded by fibrous tissue. It was a rare case of HLS in the renal artery secondary to the thrombus, with organisation and recanalisation. Balloon dilatation and stent implantation at the proximal segment of the left renal artery were performed successfully. Blood pressure was well controlled after the procedure. Conclusions The IVUS findings are helpful for forming interventional therapeutic strategies for HLS lesions in the renal artery.

Download Full-text

Use of shockwave intravascular lithotripsy for the treatment of calcified renal artery stenosis in a symptomatic subject

Future Cardiology ◽

10.2217/fca-2019-0051 ◽

2020 ◽

Vol 16 (5) ◽

pp. 419-423

Author(s):

S Schnupp ◽

I Ajmi ◽

M Sinani ◽

J Brachmann ◽

C Mahnkopf

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Left Renal Artery ◽

Shockwave Lithotripsy ◽

Refractory Hypertension ◽

Atherosclerotic Renal Artery Stenosis ◽

Wall Apposition ◽

The Right ◽

Symptomatic Subject

Aim: The use of shockwave lithotripsy for the treatment of heavily calcified atherosclerotic plaques before stenting showed great results in terms of feasibility and safety with favorable initial success. Evidence suggests that it is a useful tool to treat calcified lesions in peripheral and coronary arteries. Here, we describe the case of a patient with calcified renal artery stenosis successfully treated with the shockwave lithotripsy system. Case Report: We present a 76-year-old man with a known significant atherosclerotic renal artery stenosis and refractory hypertension. The patient received an angioplasty of the right renal artery in the first session and he was admitted for a second session to intervene in the left renal artery. The lesion was successfully treated with the lithotripsy system. Final angiography demonstrated an excellent position of the stent and good wall apposition. Conclusion: Our clinical case demonstrates that lithotripsy is safe and effective also for the treatment of the renal artery.

Download Full-text

P3564Percutaneous intervention with stent improves blood pressure and renal function in patients with transplanted renal artery stenosis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0427 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Galhardo ◽

G Kanhouche ◽

G R S Feitosa ◽

H O Campos ◽

A C B Faccinetto ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Peak Systolic Velocity ◽

Artery Stenosis ◽

Complication Rates ◽

Post Intervention ◽

Refractory Hypertension ◽

Significant Difference

Abstract Background Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing kidney transplantat, with a reported incidence ranging from 1% to 23%. Clinically important TRAS is associated with refractory hypertension, graft dysfunction and increased peak systolic velocity (PSV) above 200 cm/s. Percutaneous intervention (PI) of TRAS with or without stent is widely accepted as a viable and safe treatment option. Purpose To evaluate blood pressure and renal function in patients with TRAS undergoing PI in the following year. Methods Between January 2007 and December 2014, 310 patients with suspected TRAS underwent consecutive angiography. Of these, 173 presented significant stenosis (>60%) and were submitted to PI. Endpoints were systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (Scr), number of blood pressure medications and PSV with one month and one year post intervention. Results The mean age was 42.89±15.03 years, 78% of the population were male, 84% received kidneys from decesed donors, 94% having received a stent. The angiographic success and complication rates were 98% and 8,4% respectively. 98.7% were on blood pressure medications with 2.13±1.05 drugs/patient. Pre-intervention values of SBP, DBP and Scr were 152.8±25.28 mmHg, 92.67±16.43 mmHg and 3.04±2.75 mg/dL, respectively. After 1 month, there was a significant reduction in SBP (138.34±19.71; p<0.0001), DBP (82.52±12.2; p<0.0001) and Scr (2.13±1.39 mg/dl, p<0.0001). Following 01 year, SBP, DBP and Scr were 133.55±17.51, p<0.0001; 83.51±11.23, p<0.0001 (Figure); and Scr 1.94±1.09 mg/dL, p<0.0001 respectively. There was a significant reduction in post-intervention PSV when compared to baseline results (422.2±148.8 vs. 237.1±104.6 m/s, p<0.0001). There was no significant difference in the number of blood pressure medications pre and post intervention (2.13 vs 2.05; p=0.68). Evolution of Blood Pressure Conclusion PI with stent of TRAS was effective in improving blood pressure and renal function levels on month 1 and on year 1 with a low rate of complications.

Download Full-text

Standardized Duplex Ultrasound-Based Protocol for Early Diagnosis of Transplant Renal Artery Stenosis: Results of a Single-Institution Retrospective Cohort Study

BioMed Research International ◽

10.1155/2018/2580181 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Vincenzo Li Marzi ◽

Riccardo Campi ◽

Francesco Sessa ◽

Alessandro Pili ◽

Graziano Vignolini ◽

...

Keyword(s):

Early Diagnosis ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Stent Placement ◽

Clinical Success ◽

Duplex Ultrasound ◽

Artery Stenosis ◽

Refractory Hypertension ◽

Transplant Renal Artery Stenosis

Transplant renal artery stenosis (TRAS) is the most frequent vascular complication after kidney transplantation (KT) and has been associated with potentially reversible refractory hypertension, graft dysfunction, and reduced patient survival. The aim of the study is to describe the outcomes of a standardized Duplex Ultrasound- (DU-) based screening protocol for early diagnosis of TRAS and for selection of patients potentially requiring endovascular intervention. We retrospectively reviewed our prospectively collected database of KT from January 1998 to select patients diagnosed with TRAS. The follow-up protocol was based on a risk-adapted, dynamic subdivision of eligible KT patients in different risk categories (RC) with different protocol strategies (PS). Of 598 patients included in the study, 52 (9%) patients had hemodynamically significant TRAS and underwent percutaneous angioplasty (PTA) and stent placement. Technical and clinical success rates were 97% and 90%, respectively. 7 cases of restenosis were recorded at follow-up and treated with re-PTA plus stenting. Both DU imaging and clinical parameters improved after stent placement. Prospective high-quality studies are needed to test the efficacy and safety of our protocol in larger series. Accurate trial design and standardized reporting of patient outcomes will be key to address the current clinical needs.

Download Full-text