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

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.

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

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.

Traumatic Left Renal Artery Stenosis Managed with Splenorenal Bypass

1990 ◽  
Vol 30 (12) ◽  
pp. 1594-1596 ◽  
Author(s):  
GARY W. BARONE ◽  
MARK B. KAHN ◽  
JAMES M. COOK ◽  
BERNARD W. THOMPSON ◽  
ROBERT W. BARNES ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Artery Stenosis ◽  
Left Renal Artery

Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits

2003 ◽  
Vol 10 (3) ◽  
pp. 546-556 ◽  
Author(s):  
David A. Axelrod ◽  
A. Mark Fendrick ◽  
Ruth C. Carlos ◽  
Robert J. Lederman ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Analysis ◽  
Renal Artery ◽  
Incremental Cost ◽  
Renal Artery Stenosis ◽  
Cost Effective ◽  
Artery Stenosis ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Refractory Hypertension

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.

scholarly journals Renal artery stenosis of atherosclerotic etiology – the single kidney surgical recurrence 12 years after nephrectomy

2016 ◽  
Vol 63 (3) ◽  
pp. 251-254
Author(s):  
Maria Daniela Tănăsescu ◽  
◽  
Marcel Pălămar ◽  
Mihai Ovidiu Comşa ◽  
Alexandru Mincă ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Left Kidney ◽  
Secondary Hypertension ◽  
Artery Stenosis ◽  
The Other ◽  
Left Renal Artery ◽  
Arterial Blood ◽  
The Moment ◽  
The Right

Objectives. Renal artery stenosis, as main cause of renovascular secondary hypertension, is mainly caused by atherosclerosis of large vessels and is clinically characterized by resistant or malignant hypertension, impacting the kidney function to various degrees. The present article brings into attention the case of a patient which developed renal artery stenosis on the left kidney, the same condition occurring 12 years later on the right kidney. Material and method. Our patient was initially diagnosed at the age of 48 with complete occlusion of the left renal artery, for which left nephrectomy was performed, while the right artery was normal. Twelve years later she presents with renal artery stenosis on the right kidney, which is treat by stent-angioplasty. Results. After surgery, the patient’s evolution was positive, with amelioration of the laboratory values, in parallel to the arterial blood pressure. Discussions. The probability that, in the moment of diagnosis of renal artery stenosis with progressive evolution to occlusion caused by atherosclerosis, the other artery would be normal, both seen by ultrasonography and angiography, while years later to develop stenosis, is minimal. Up to present, the literature holds little evidence of such similar cases. Conclusions. In the particular case of patients that were diagnosed with severe renal artery stenosis of atherosclerotic origin and had only one of the arteries affected, it is necessary to keep a permanent monitoring, justified by the risk of development of the same pathology to the other artery

scholarly journals Thoracolumbar Junction Syndrome Accompanying Renal Artery Stenosis: A Case Repor

2020 ◽  
Vol 44 (1) ◽  
pp. 85-89
Author(s):  
Kyudong Noh ◽  
Jong Burm Jung ◽  
Jeong Won Seong ◽  
Doh-Eui Kim ◽  
Dongrak Kwon ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Correct Diagnosis ◽  
Flank Pain ◽  
Artery Stenosis ◽  
Common Reason ◽  
Thoracolumbar Junction ◽  
Left Renal Artery ◽  
Paravertebral Muscles ◽  
Minor Improvement

Flank pain is a common reason for visits to the emergency room. The most common reason warranting hospital visits are urology-related problems. However, there are many other causes, such as musculoskeletal lesions, that difficult to achieve a correct diagnosis. Here, we describe a rare case of flank pain caused by thoracolumbar junction syndrome, accompanying renal artery stenosis. A 54-year-old male with hypertension presented with severe left flank pain for 1 week. Initially, he was diagnosed with left renal artery stenosis by computed tomography and decreased renal function on renal scan (Tc-99m DTPA). Although a stent was inserted into the left renal artery, flank pain persisted with only minor improvement. Through detailed physical examination, he was finally diagnosed with thoracolumbar junction syndrome. After three injections in the left deep paravertebral muscles at the T10–T12 levels, flank pain completely ceased. Clinicians must consider thoracolumbar junction syndrome, when treating patients with flank pain.

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

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.

Stenosis-dependent role of nitric oxide and prostaglandins in chronic renal ischemia

2002 ◽  
Vol 282 (5) ◽  
pp. F859-F865 ◽  
Author(s):  
Hirobumi Tokuyama ◽  
Koichi Hayashi ◽  
Hiroto Matsuda ◽  
Eiji Kubota ◽  
Masanori Honda ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Renal Plasma Flow ◽  
Renal Hemodynamics ◽  
Renal Ischemia ◽  
Artery Stenosis ◽  
Left Renal Artery ◽  
Severe Stenosis

The role of nitric oxide (NO) and prostaglandins (PG) in modifying renal hemodynamics was examined in clipped and nonclipped kidneys of unilateral renal artery stenosis. Chronic unilateral renal ischemia was established by 4-wk-clipping the left renal artery of canine kidneys, and renal interstitial nitrate+nitrite and PGE2 contents were evaluated by the microdialysis technique. Unilateral renal artery stenosis caused 45 ± 1 and 73 ± 1% decrements in renal plasma flow (RPF) in moderately and severely clipped kidneys and 21 ± 3% decrements in nonclipped kidneys with severe stenosis. Renal nitrate+nitrite decreased in moderately (−31 ± 1%) and severely clipped kidneys (−63 ± 4%). N ω-nitro-l-arginine methyl ester reduced RPF (−56 ± 3%) and glomerular filtration rate (GFR; −54 ± 3%) in moderately clipped kidneys, whereas this inhibitory effect was abolished in severely clipped kidneys. In contrast, renal PGE2 contents increased modestly in moderate clipping and were markedly elevated in severely clipped kidneys (from 111 ± 7 to 377 ± 22 pg/ml); sulpyrine impaired renal hemodynamics only in severely clipped kidneys. In contralateral nonclipped kidneys, although renal PGE2 was not increased, sulpyrine reduced RPF (−32 ± 1%) and GFR (−33 ± 3%) in severe stenosis. Collectively, NO plays a substantial role in maintaining renal hemodynamics both under basal condition and in moderate renal artery stenosis, whereas the contributory role shifts from NO to PG as renal artery stenosis progresses. Furthermore, because intrarenal angiotensin II is reported to increase in nonclipped kidneys, unilateral severe ischemia may render the nonclipped kidney susceptible to PG inhibition.

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