Clasificación y posibilidades terapéuticas de los aneurismas saculares de arteria renal / Classification and therapeutic possibilities of saccular aneurysms of the renal artery

Introducción. El tratamiento del aneurisma sacular de arteria renal (ASAR) puede abarcar en la actualidad diversas posibilidades, tanto conservadoras, percutáneas como quirúrgicas. Objetivo. Clasificar, tras la revisión de nuestra experiencia, el ASAR, con vistas a facilitar su manejo terapéutico. Pacientes y métodos. El análisis de una base de datos recogidos de forma prospectiva demuestra la existencia de ocho pacientes tratados de ASAR localizado en el tronco principal, primera bifurcación o rama lobular, entre enero de 1978 y junio de 2000. Representan un 30,7 por ciento de todos los aneurismas de arteria renal. Resultados. Se han diferenciado tres tipos de aneurisma sacular, en base a criterios fundamentalmente terapéuticos: tipo I, aneurisma del ostium de arteria renal, generalmente asociado a aneurisma de aorta (dos casos); tipo II, aneurisma sacular pediculado de base ancha (cuatro casos), y tipo III, aneurisma sacular pediculado de base estrecha (dos casos). Conclusión. La clasificación del aneurisma sacular de arteria renal en los tres tipos descritos puede facilitar la decisión sobre las distintas posibilidades terapéuticas. Creemos que los tipos I y II tienen, hoy día, un tratamiento fundamentalmente quirúrgico. Los tipos III pueden tratarse inicialmente de forma percutánea. (AU)

[Treatment of essential arterial hypertension with hypercholesterolemia. Effects of an alpha-adrenergic blocker and an inhibitor of the angiotensin converting enzyme]. / Tratamiento de la hipertensión arterial esencial con hipercolesterolemia. Efectos de un bloqueador alfaadrenérgico y un inhibidor de la enzima conversiva de la angiotensina.

BACKGROUND: Hypertension and hypercholesterolemia are frequently associated with this leading to considerable cardiovascular risk. METHODS: An open parallel randomized study was performed in which the effects of doxazosin, an alpha-adrenergic blocker and enalapril, an inhibitor of the angiotensin converting enzyme were compared in 70 patients with essential high blood pressure and plasma cholesterol levels greater than 240 mg/dl. Following 2-4 weeks of placebo administration the patients were randomly treated with one of the two drugs. When required doses were increased and hydrochlorothiazide added until blood pressure lower than 160/95 mmHg was achieved. After this period the patients were observed for a minimum of 8 weeks. The mean length of the study was of 22 weeks. RESULTS: Both drugs significantly reduced blood pressure without modifying cardiac frequency. Doxazosin tended to favorably modify the lipid profile of the plasma while enalapril significantly reduced the levels of cholesterol, lipids and high density lipoproteins (HDL). Upon termination of the study the total HDL/cholesterol index increased 8.6% in those treated with doxazosin and decreased 5.5% in those receiving enalapril (p < 0.05). CONCLUSIONS: Although doxazosin and enalapril are potent antihypertensive drugs, the effects on plasma lipid obtained with doxazosin indicate that a reduction in cardiovascular risk was achieved with this drug in the patients included in this study.