Atherosclerotic renovascular disease is a cardiovascular condition that is associated with renal artery stenosis (RAS); treatment with statins and renin–angiotensin antagonists can provide cardiovascular protection Renal impairment associated with atherosclerotic RAS is both a marker and a risk factor for cardiovascular disease
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Is medical therapy without stenting the preferred management strategy for atherosclerotic renal-artery stenosis?
Atherosclerotic renal artery stenosis (ARAS) typically involves the ostium and/or proximal one-third of the renal artery and often the adjacent aorta. 2 However, segmental and diffuse intrarenal atherosclerosis may also be observed, especially in advanced cases. 3. We reviewed the literature using PubMed to search for relevant recent ...
What is the prognosis of atherosclerotic renal artery stenosis?
· The STAR study evaluated the effects of stenting of the renal arteries and the best medical therapy versus best medical therapy alone on the progression of renal impairment in patients with ARAS who had a creatinine clearance of <80 mL/min/1.73 m 2. The best medical therapy included antihypertensive agents, aspirin, and a statin.
What are the treatment options for ostial renal stenosis?
atherosclerotic renal artery stenosis. Blood pressure control in CORAL was achieved using a similar number of antihypertensive medica- tions, regardless of randomization to stenting or med- ical therapy alone (3.3 vs 3.5). Importantly, there was a15 –to 16 mm Hg improvement in systolic blood pressure in both study arms that was maintained
Who is eligible for renal-artery stenosis treatment?
· Historically, surgicalrepair of the blocked artery was the definitive treatment for ARAS, but newerprocedures have largely supplanted surgery. Currently, the most common …
What is the treatment for renal artery stenosis?
Procedures to treat renal artery stenosis may include: Renal angioplasty and stenting. In this procedure, doctors widen the narrowed renal artery and place a device (stent) inside your blood vessel that holds the walls of the vessel open and allows for better blood flow. Renal artery bypass surgery.
What medication class should be used in patients with renal artery stenosis?
ACE inhibitors are probably second-line antihypertensives for patients with unilateral renal artery stenosis and two kidneys. First-line antihypertensives are diuretics, beta-blockers and calcium-channel blockers.
What is the gold standard for renal artery stenosis?
Because of the possibility of cure, screening measures for renal artery stenosis are warranted in hypertensive patients with clinical features suggestive of renovascular disease. For a long time, angiography has been considered the 'gold standard' in screening for arterial stenosis.
Do vascular surgeons treat renal artery stenosis?
Two surgical procedures that your physician may use to treat renal artery stenosis are endarterectomy and surgical bypass. In a renal endarterectomy, a vascular surgeon removes the inner lining of your renal artery, which contains the plaque. This procedure removes the plaque and leaves a smooth, wide-open artery.
Why are ACE inhibitors contraindicated in renal artery stenosis?
Abstract. Angiotensin-converting enzyme inhibitors (ACEIs) are contraindicated in patients with bilateral renal artery stenosis due to risk of azotemia resulting from preferential efferent arteriolar vasodilation in the renal glomerulus due to inhibition of angiotensin II.
Do ACE inhibitors cause renal artery stenosis?
ACE inhibitors were developed in the 1970s and have revolutionised the management of renal and cardiac diseases. Unfortunately, as with most drugs, there are side-effects and contra-indications (including significant aortic and renal artery stenosis).
What is a renal angiography?
A renal angiogram is an imaging test to look at the blood vessels in your kidneys. Your healthcare provider can use it to look at the ballooning of a blood vessel (aneurysm), narrowing of a blood vessel (stenosis), or blockages in a blood vessel.
What causes renal artery stenosis?
The two main causes of renal artery stenosis include: Buildup on kidney (renal) arteries. Fats, cholesterol and other substances (plaque) can build up in and on your kidney artery walls (atherosclerosis).
What is captopril Renography?
A captopril renal scan is used to evaluate for the presence of renal artery stenosis and renovascular hypertension. This captopril scan is performed in order to rule out renal artery stenosis in patients with high blood pressure.
Who does surgery for renal artery stenosis?
The procedures are performed in a hospital by a vascular surgeon—a doctor who specializes in repairing blood vessels. Anesthesia is needed. Angioplasty and stenting. Angioplasty is a procedure in which a catheter is put into the renal artery, usually through the groin, just as in a catheter angiogram.
Is renal artery stenosis curable?
Unlike treatment of fibromuscular dysplasia, cure of atheromatous renal artery stenosis by angioplasty alone is rare. Most atheromatous renal artery stenosis is due to aortic plaques encroaching on the ostium of the renal artery.
Who performs renal artery stenting?
Your interventional cardiologist or other vascular specialist may recommend renal (kidney) artery angioplasty and stenting to open the blocked arteries and restore blood flow to your legs. Angioplasty is a procedure performed in the catheterization laboratory, or “cath lab,” in a hospital.
What are therapeutic options for renal stenosis?
Therapeutic options include medical treatment only or revascularization procedures. Purpose: To compare the effects of medical treatment and revascularization on clinically important outcomes in adults with atherosclerotic renal artery stenosis.
Does available evidence support one treatment?
Available evidence did not adequately assess adverse events or baseline characteristics that could predict which intervention would result in better outcomes. Limitations: The evidence from direct comparisons of interventions is sparse and inadequate to draw robust conclusions. Conclusions: Available evidence does not clearly support one treatment ...
What is the primary end point of a renal failure?
The primary end point was the occurrence of a major cardiovascular or renal event — a composite of death from cardiovascular or renal causes, stroke, myocardial infarction, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for permanent renal-replacement therapy.
Who donated the Angioguard device?
Medications were donated by AstraZeneca and Pfizer. The short-tip Angioguard device was donated by Cordis, and supplemental financial support was provided by both Cordis and Pfizer. None of the funders had any role in the design of the trial protocol, in the collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication. The trial was conducted under the guidance of an independent data and safety monitoring board convened by the National Heart, Lung, and Blood Institute.
Is renal stenosis a public health issue?
Given the prevalence of atherosclerotic renal-artery stenosis, this condition is an important public health issue. If stenting prevents the progression of chronic kidney disease and lowers blood pressure, it has the potential to prevent serious health consequences, including adverse cardiovascular and renal events. In contrast, if stenting confers neither of these benefits, it is likely to incur substantial cost without a public health advantage. Therefore, we performed a randomized clinical trial to determine the effects of renal-artery stenting on the incidence of important cardiovascular and renal adverse events. 17
Does renal stenting help with hypertension?
Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease.
Is renal stenosis a common problem in the elderly?
Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain.
How long is a congestive heart failure patient hospitalized?
Hospitalization for congestive heart failure was included in the analysis if the patient was hospitalized for 12 hours or longer because of documented signs and symptoms of heart failure and received intravenous therapy (vasodilators, diuretics, or inotropes) during the hospital stay.
Why are survival curves truncated?
Survival curves are truncated at 5 years owing to instability of the curves because few participants remained in the study after 5 years.