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1.
Cardiovasc Intervent Radiol ; 42(9): 1293-1301, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31267151

RESUMO

PURPOSE: To determine primary rates in small-diameter renal arteries, including complex bifurcation lesions, treated with drug-eluting stents (DES) in patients with atherosclerotic renal artery stenosis. MATERIALS AND METHODS: This is a retrospective single-institution study. A total of 37 patients with 39 stented renal arteries were included. Patient and procedural data were obtained from the electronic medical record. Survival free from restenosis was estimated using the Kaplan-Meier method with patients stratified into two groups based on renal artery diameters (≤ 3.5 mm or > 3.5 mm). Univariate Cox proportional models were used to estimate hazard ratios associated with clinical and angiographic variables. RESULTS: Average renal artery diameter at time of treatment was 3.4 mm ± 0.4 mm. The median survival free from restenosis was 992 days, with 11 out of 37 (29.7%) developing an in-stent restenosis. Renal arteries < 3.5 mm in diameter had similar patency rates as renal arteries > 3.5 mm (P = 0.33). The 1-, 2-, and 5-year patency rates were 71%, 63%, and 38%, respectively. History of stroke was the only comorbidity to portend a significantly greater rate of restenosis (hazard ratio 3.77; 95%CI, 1.05-13.6; P = 0.04). Medications did not statistically alter the risk of restenosis. CONCLUSION: Revascularization of renal arteries with DES achieved similar primary patency rates irrespective of renal artery diameter. Stent configuration was not associated with time to renal replacement therapy or all-cause mortality. LEVEL OF EVIDENCE: Level 3, Cohort Study.


Assuntos
Aterosclerose/epidemiologia , Aterosclerose/terapia , Stents Farmacológicos , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/terapia , Artéria Renal/patologia , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/patologia , Estudos de Coortes , Constrição Patológica , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Obstrução da Artéria Renal/patologia , Estudos Retrospectivos , Fatores de Risco , Tempo , Resultado do Tratamento
2.
Ann Vasc Surg ; 58: 248-254.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30721728

RESUMO

BACKGROUND: The aim of our study is to assess the prevalence of concomitant arterial abnormalities (true aneurysms of iliac, common femoral, renal, visceral arteries and stenoses of iliac and renal arteries) in patients with abdominal aortic aneurysm, and to evaluate whether the type of the aneurysm (suprarenal versus solely infrarenal) is associated with this prevalence. METHODS: In this retrospective cross-sectional study, we assessed computed tomography angiography scans of 933 patients with abdominal aortic aneurysm, including thoracoabdominal aortic aneurysms type II-IV, with no history of abdominal aortic surgery. We compared 2 groups of patients: group 1 (n = 859) with solely infrarenal abdominal aortic aneurysm and group 2 (n = 74) with the suprarenal aneurysm component. Patients with history of aortic dissection or thoracoabdominal aortic aneurysms type I and V were excluded from the study. All computed tomography angiography scans were visually assessed by 2 independent experienced physicians. RESULTS: Study group comprised 933 patients with the median age of 73.0 years, 83.8% of whom were male. We observed higher prevalence of common iliac artery aneurysms (44.6% vs. 30.6%, P = 0.013), internal iliac artery aneurysms (28.4% vs. 18.0%, P = 0.03), common femoral artery aneurysms (13.5% vs. 4.4%, P < 0.001), visceral artery aneurysms (5.4% vs. 1.2%, P = 0.019), renal artery stenosis (20.3% vs. 5.2%, P < 0.001), renal atrophy (6.7% vs. 1.1%, P = 0.004), and severe chronic kidney disease (14.1% vs. 1.8%, P < 0.001) in group 2 compared to group 1. There were no significant differences in the prevalence of iliac arterial stenoses between the groups. CONCLUSIONS: Among patients with abdominal aortic aneurysm, concomitant aneurysms and renal artery stenosis are more common in patients with suprarenal component when compared to those with solely infrarenal presentation.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma Ilíaco/epidemiologia , Obstrução da Artéria Renal/epidemiologia , Vísceras/irrigação sanguínea , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Comorbidade , Angiografia por Tomografia Computadorizada , Estudos Transversais , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Prevalência , Obstrução da Artéria Renal/diagnóstico por imagem , Estudos Retrospectivos
3.
Am J Med ; 132(5): 647-651, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30615861

RESUMO

BACKGROUND: Takayasu arteritis is a rare large-vessel vasculitis that predominantly affects females of Asian descent. This retrospective analysis was performed to increase understanding of the epidemiology of the disease in the United States. METHODS: We performed a retrospective cohort study in 2 tertiary centers. Patients were selected according to the American College of Rheumatology classification criteria for Takayasu arteritis. Data collected included demographic characteristics and details of physical examinations, treatments, and surgical interventions. Data were managed with REDCap (Research Electronic Data Capture) tools. RESULTS: The study included 57 patients. The female:male ratio was 4.2:1, the median age at diagnosis was 29 years, 61.4% of the patients were Caucasians, and 86% of the patients had stenosis on imaging. Hata V was the most common angiographic classification (37.5% of patients). Vascular interventions were required in 43.9% of patients. The most frequent complications were hypertension (56.1%), renal artery stenosis (28.1%), and aortic insufficiency (19.3%). CONCLUSIONS: Takayasu arteritis continues to be a rare large-vessel vasculitis. In the United States, it tends to affect predominantly Caucasian females, with cervicobrachial involvement. This cohort reflects the morbidity, multiple interventions, and complications experienced by patients with Takayasu arteritis.


Assuntos
Doenças da Aorta , Hipertensão , Administração dos Cuidados ao Paciente , Obstrução da Artéria Renal , Arterite de Takayasu , Adulto , Angiografia/métodos , Angiografia/estatística & dados numéricos , Doenças da Aorta/epidemiologia , Doenças da Aorta/etiologia , Artérias/diagnóstico por imagem , Grupos Étnicos , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Masculino , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Fatores Sexuais , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/epidemiologia , Arterite de Takayasu/fisiopatologia , Estados Unidos/epidemiologia
4.
Vascular ; 27(2): 190-198, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30547720

RESUMO

OBJECTIVE: Data about renal artery stenosis association with left ventricular remodeling in patients coexisting with coronary artery disease are scanty. METHODS: Patients with suspected both coronary artery disease and renal artery stenosis undergoing coronary and renal arteriography between October 2013 and December 2015 were prospectively enrolled. Left ventricular remodeling patterns were compared among different severity of renal artery stenosis group. Logistic regression was done to investigate the determinants of the left ventricular morphology. RESULTS: The overall prevalence of left ventricular hypertrophy was 40.5%, the highest in bilateral renal artery stenosis group compared to unilateral or normal ones (65.4% versus 41.8% versus 34.8%, p = 0.012). Significantly lower estimated glomerular filtration rate and higher cystatin C level were found in bilateral renal artery stenosis group than that in other two groups. Multivariate regression analysis showed that bilateral renal artery stenosis was associated with increased left ventricular hypertrophy and concentric hypertrophy with statistical significance (adjusted odds ratio = 2.909 (95%CI: 1.063-7.961), and 3.021 (95%CI: 1.136-8.033)). In addition, estimated glomerular filtration rate level was also related to left ventricular hypertrophy, while there was no significant interaction between renal artery stenosis and coronary artery disease on left ventricular hypertrophy/concentric hypertrophy occurrence. CONCLUSIONS: Bilateral renal artery stenosis is significantly associated with increased left ventricular hypertrophy/concentric hypertrophy in patients with suspected concomitant coronary and renal artery disease, while no synergic effect could be found in coronary artery disease.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Obstrução da Artéria Renal/fisiopatologia , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , China/epidemiologia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
5.
Nephron ; 140(4): 257-264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30253412

RESUMO

BACKGROUND/AIMS: Renal artery stenosis (RAS) is a known cause of secondary hypertension and renal failure. Although renal artery angiography is the gold standard for diagnosing RAS, a simple method to estimate if patients will develop RAS is required. The aim of this retrospective study was to develop a simple risk score to predict significant RAS. METHODS: Four thousand one hundred seventy-seven patients who underwent renal angiography between 2002 and 2016 at Tehran Heart Center were included. Significant RAS was defined as narrowing of the renal artery by at least 70%. Multiple predictors of the RAS were determined using multivariable logistic regression with a backward elimination method. The scoring system obtained from the final model was presented as nomogram. The possible nonlinear effect of continuous variables was evaluated using restricted cubic splines. Overfitting of the final model was assessed applying the tenfold cross-validation method. Model performance was checked using calibration plot as well as Hosmer-Lemeshow goodness of fit test, and area under the receiver operating characteristics (ROC) curve. RESULTS: The prevalence of RAS was 14.1%. Female sex (OR [95% CI]: 1.53 [1.26-1.85]), hypertension (OR [95% CI]: 1.38 [1.08-1.77]), estimated glomerular filtration rate (OR [95% CI]: 0.98 [0.97-0.98]), body mass index (OR [95% CI]: 0.97 [0.95-0.99]), and age (OR [95% CI]: 1.01 [1.00-1.02]) were determined as the multiple predictors of RAS. The area under the ROC curve of the final predictive model was 0.702 (95% CI: 0.679-0.725). CONCLUSION: This model assesses the risk of RAS using available information. This model can be used for both clinical and research purposes.


Assuntos
Obstrução da Artéria Renal/diagnóstico , Adulto , Idoso , Algoritmos , Angiografia , Calibragem , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prevalência , Curva ROC , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/genética , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Caracteres Sexuais
6.
Artigo em Inglês | MEDLINE | ID: mdl-29623176

RESUMO

The column in this issue is supplied by Hassan N. Ibrahim, M.D., director of the Division of Kidney Diseases and Hypertension in the Department of Medicine at Houston Methodist Hospital and a fellow of the American Society of Nephrology. Dr. Ibrahim joined Houston Methodist in May 2017 after serving as a professor of medicine and chief of nephrology at the University of Minnesota.


Assuntos
Procedimentos Endovasculares/instrumentação , Hipertensão Renovascular/prevenção & controle , Obstrução da Artéria Renal/terapia , Stents , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Humanos , Hipertensão Renovascular/epidemiologia , Hipertensão Renovascular/fisiopatologia , Seleção de Pacientes , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
7.
Kidney Int ; 93(1): 245-251, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28863945

RESUMO

Takayasu's arteritis is a rare systemic vasculitis mainly affecting the aorta and its major branches. Previous studies have suggested that almost half of the Asian Takayasu's patients have renal artery involvement. However, due to the rarity of the disease, little is known about renal artery involvement in Chinese Takayasu's arteritis patients. Here, we retrospectively reviewed and analyzed 411 patients diagnosed with Takayasu's arteritis in our center to explore the clinical features of renal artery involvement in this group of patients. Of these, 201 patients were diagnosed to have renal artery involvement, with stenosis (78.1%) the most common renal artery pattern. Compared to those without, patients with renal artery involvement were significantly younger at disease onset (23.5 vs 25.6 years) and more frequently had hypertension (74.6% vs 28.1%). Congestive heart failure (22.4% vs 7.6%) and pulmonary hypertension (19.9% vs 9.5%) were both significantly more prevalent among patients with than those without renal artery involvement. The estimated glomerular filtration rate (eGFR) significantly decreased as the severity of renal artery stenosis increased. Age at disease onset older than 24 years (odds ratio 6.06 [95% Confidence Interval 2.76-13.3]), disease duration longer than 19 months (3.35 [1.52-7.4]) and renal artery involvement (8.7 [3.8-20.1]) were independent risk factors for renal dysfunction (eGFR under 90 mL/min/1.73m2) among patients with Takayasu's arteritis. Thus, patients with renal artery involvement have more severe cardiac and renal dysfunction compared to those without. The eGFR is correlated negatively with the severity of renal artery stenosis.


Assuntos
Obstrução da Artéria Renal/epidemiologia , Artéria Renal/patologia , Arterite de Takayasu/epidemiologia , Adolescente , Adulto , China/epidemiologia , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão Pulmonar/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Masculino , Prevalência , Prognóstico , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/patologia , Obstrução da Artéria Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Arterite de Takayasu/patologia , Adulto Jovem
8.
Am J Hypertens ; 31(2): 139-149, 2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-28985335

RESUMO

Renovascular disease (RVD) remains a major cause of secondary and treatment-resistant hypertension. Most cases are related either to fibromuscular or atherosclerotic lesions, but a variety of other causes including arterial dissection, stent occlusion, and embolic disease can produce the same syndrome. Recent studies emphasize the kidney's tolerance to moderate flow reduction during antihypertensive drug therapy and the relative safety of medical therapy to control blood pressure. Several prospective trials in moderate RVD fail to identify major benefits from endovascular revascularization for moderate atherosclerotic disease. However, high-risk and progressive renovascular syndromes are recognized to be relatively refractory to medical therapy only and respond better to combining renal revascularization with ongoing medical therapy. Clinicians caring for complex hypertension should be familiar with pathogenic pathways, imaging techniques, and a rational approach to managing renovascular hypertension in the current era.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Procedimentos Endovasculares , Hipertensão Renovascular/terapia , Obstrução da Artéria Renal/cirurgia , Animais , Anti-Hipertensivos/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/epidemiologia , Hipertensão Renovascular/fisiopatologia , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Fatores de Risco , Stents , Resultado do Tratamento
9.
Rev Assoc Med Bras (1992) ; 64(8): 723-728, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30673043

RESUMO

AIM: To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS: Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS: Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Doppler echocardiography showed cardiac abnormalities in 16/21 (76%) hypertensive patients. CONCLUSION: Cardiac abnormalities and hypertension in patients with Williams-Beuren syndrome are common. Thus, thorough evaluation and follow-up are necessary to reduce cardiovascular risks and mortality of these patients.


Assuntos
Hipertensão/etiologia , Obstrução da Artéria Renal/complicações , Síndrome de Williams/complicações , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Ecocardiografia Doppler , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Incidência , Lactente , Angiografia por Ressonância Magnética , Masculino , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Ultrassonografia Doppler , Síndrome de Williams/diagnóstico por imagem , Síndrome de Williams/epidemiologia , Adulto Jovem
10.
Curr Hypertens Rev ; 13(2): 93-103, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28782466

RESUMO

BACKGROUND: Renal artery stenosis (RAS) has a high prevalence in older patients, especially in the context of general atherosclerosis. It is frequently associated with resistant hypertension and impaired renal function and their attendant consequences. The issue whether revascularization via percutaneous renal angioplasty and stenting (PRA/S) can benefit these patients remains unsettled. OBJECTIVE: To present a case series of patients with refractory hypertension and RAS undergoing PRA/S and also to provide an extensive review of the literature on the current status of PRA/S for resistant hypertension. METHODS: Data of all consecutive patients undergoing PRA/S by a single operator over 1 year were prospectively collected. These were 9 patients with hypertension refractory to drug therapy who also had other clinical cardiac problems that led to their hospitalization, including flash pulmonary edema and coronary artery disease. They were all receiving ≥3 antihypertensive drugs and renal angiography revealed critical RAS (unilateral in 3 and bilateral in 6). In addition, an extensive literature review of the topic was carried out in PubMed, Scopus and Google Scholar. RESULTS: PRS was successful in all 9 high-risk RAS patients with resistant hypertension (5 men, mean age 71 years) without complications and helped in bringing under control their elevated blood pressure (BP) and in maintaining their renal function over a mean of 21 months. Literature review of this controversial topic indicates that in carefully selected patients, PRA/S may play an important role in controlling BP, alleviating symptoms and perhaps preventing renal failure, albeit without concrete evidence of significantly affecting hard end-points of renal events, major cardiovascular events and death. Randomized controlled studies (RCTs), including a large one (CORAL trial), although heavily criticized, have not provided evidence in favor of revascularization. Although RCTs are rather neutral, a multitude of prospective, observational cohort studies, comparing the outcomes of patients after PRA/S have demonstrated significant improvement in systolic and diastolic BP in about two thirds and improvement and/or stabilization in renal function in 30-40% of patients undergoing PRA/S. Nevertheless, the issue remains unsolved and a subject of future studies for further more definitive settlement. Suggestions have been made to adopt physiological and functional renal lesion assessment that may enhance patient selection, at least for RAS cases of moderate lesion severity. Based on this small case series and on exhaustive literature review, an algorithm for approaching patients with significant RAS is herein proposed. CONCLUSION: In high-risk RAS patients with truly resistant hypertension, flash pulmonary edema, and/or rapid deterioration of renal function, PRA/S, a procedure with currently high technical success, may constitute the only viable option. Importantly, despite the unfavorable results of RCTs, current guidelines have not yet changed and clinicians should continue to abide by them. They recommend PRA/S as a reasonable option for patients with hemodynamically significant (especially ostial) RAS and uncontrolled, resistant or malignant hypertension, recurrent, unexplained congestive heart failure or pulmonary edema or unstable angina.


Assuntos
Angioplastia com Balão/instrumentação , Pressão Sanguínea , Hipertensão Renovascular/terapia , Obstrução da Artéria Renal/terapia , Artéria Renal/fisiopatologia , Stents , Idoso , Angioplastia com Balão/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Constrição Patológica , Resistência a Medicamentos , Feminino , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/epidemiologia , Hipertensão Renovascular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Resultado do Tratamento
11.
Hypertension ; 70(3): 652-658, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28716989

RESUMO

Fibromuscular dysplasia (FMD) commonly affects the renal and cervical arteries but has been described to affect other vascular beds as well. The prevalence of and clinical characteristics associated with multisite FMD (string-of-beds or focal stenoses affecting at least 2 vascular beds) are not known. In the prospective ARCADIA registry (Assessment of Renal and Cervical Artery Dysplasia), symptomatic patients with renal artery (RA) FMD underwent tomographic- or magnetic resonance-angiography from the aortic arch to the intracranial arteries and those with cervical FMD from the diaphragm to the pelvis. Of 469 patients (84.0% women), 225 (48.0%) had multisite FMD. In addition, 86 of 244 patients with single-site disease had dissections or aneurisms affecting other vascular beds, totaling 311 patients (66.3%) with lesions in >1 vascular bed. Among patients with a cerebrovascular presentation, the prevalence of RA lesions was higher in patients with than in those without hypertension (odds ratio, 3.4; 95% confidence interval, 1.99-6.15). Among patients with a renal presentation, the prevalence of cervical lesions was higher in patients with bilateral than in those with unilateral RA lesions (odds ratio, 1.9; 95% confidence interval, 0.99-3.57). In conclusion, FMD is a systemic arterial disease. At least 2 vascular beds were affected by dysplastic stenoses in 48.0% of cases and by dysplastic stenoses, aneurysms, and dissections in 66.1% of cases. RA imaging should be proposed to hypertensive patients with a cerebrovascular presentation. Cervical artery imaging should be considered in patients with a renal presentation and bilateral RA lesions. CLINICAL TRIAL REGISTRATION: URL: www.Clinicaltrials.gov. Unique identifier: NCT02884141.


Assuntos
Aneurisma Dissecante , Aneurisma , Estenose das Carótidas , Displasia Fibromuscular , Hipertensão , Obstrução da Artéria Renal , Adulto , Idoso , Aneurisma/diagnóstico , Aneurisma/etiologia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Bélgica/epidemiologia , Determinação da Pressão Arterial/métodos , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Displasia Fibromuscular/complicações , Displasia Fibromuscular/diagnóstico , Displasia Fibromuscular/epidemiologia , Displasia Fibromuscular/fisiopatologia , França/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Artéria Renal/diagnóstico por imagem , Artéria Renal/patologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/epidemiologia , Índice de Gravidade de Doença
12.
Ann Cardiol Angeiol (Paris) ; 66(3): 154-158, 2017 Jun.
Artigo em Francês | MEDLINE | ID: mdl-28554696

RESUMO

INTRODUCTION: Takayasu arteritis (TA) is an uncommon large vessel arteritis. Lesions produced by the inflammatory process can be stenotic, occlusive, or aneurysmal. Vascular changes lead to the main complications, including hypertension, most often due to renal artery stenosis or, more rarely, stenosis of the suprarenal aorta. AIM OF STUDY: Our study will assess the prevalence of hypertension during TA and describe its clinical profile. MATERIAL AND METHODS: Among 279 patients with TA resulting from single center study over a period of 35 years, we collected 128 hypertensive patients. All have benefited from a vascular exploration. Renal angiography was performed in 85 patients. The classification of Lupi Herrera allowed us to distribute our patients according to the topography of their lesions. Patients are classified according to the degree of severity of their hypertension. Results are statistically analyzed with SPSS 10.0 database. RESULTS: The prevalence of hypertension is 45.8%, mainly affecting young women (87%). It is indicative of arteritis in 24.7%. Its diagnosis is difficult and delayed when arterial stenosis exist: inter-arm blood pressure difference (53.8%), inverse coarctation (30.4%) or unmeasurable blood pressure at the 4 limbs (6.8%). In 54% of cases, hypertension was due to a renal artery stenosis. The presence of arterial hypertension was associated to a poor prognosis: it was severe in 54% of patients and was linked to 70% of deaths observed. CONCLUSION: Arterial hypertension is common during TA. It remains a factor of bad prognosis specially when renovascular hypertension is present.


Assuntos
Hipertensão/epidemiologia , Arterite de Takayasu/epidemiologia , Adulto , Argélia/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Prognóstico , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
J Clin Hypertens (Greenwich) ; 19(1): 13-22, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27759186

RESUMO

European guidelines recommend that patients with hypertension be assessed for asymptomatic organ damage and secondary causes. The authors propose that a single magnetic resonance imaging (MRI) scan can provide comprehensive first-line imaging of patients assessed via a specialist hypertension clinic. A total of 200 patients (56% male, aged 51±15 years, office BP 168±30/96±16 mm Hg) underwent MRI of the heart, kidneys, renal arteries, adrenals and aorta. Comparisons were made with other imaging modalities where available. A total of 61% had left ventricular hypertrophy (LVH), 14% had reduced ejection fraction, and 15 patients had myocardial infarcts. Echocardiography overdiagnosed LVH in 15% of patients and missed LVH in 14%. Secondary causes were identified in 14.5% of patients: 12 adrenal masses, 10 renal artery stenoses, seven thyroid abnormalities, one aortic coarctation, one enlarged pituitary gland, one polycystic kidney disease, and one renal coloboma syndrome. This comprehensive MRI protocol is an effective method of screening for asymptomatic organ damage and secondary causes of hypertension.


Assuntos
Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Idoso , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/epidemiologia , Coloboma/diagnóstico por imagem , Coloboma/epidemiologia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Hipófise/diagnóstico por imagem , Hipófise/patologia , Doenças Renais Policísticas/diagnóstico por imagem , Doenças Renais Policísticas/epidemiologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Insuficiência Renal/diagnóstico por imagem , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Volume Sistólico , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/epidemiologia
15.
Eur J Vasc Endovasc Surg ; 53(3): 380-385, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27919610

RESUMO

OBJECTIVE/BACKGROUND: The objective was to determine the prevalence and clinical determinants of renal artery stenosis (RAS) in patients undergoing digital subtraction angiography (DSA) for the assessment of peripheral artery disease (PAD), and to evaluate its prognostic significance. METHODS: All DSAs performed from January 2000 to January 2006 were retrospectively reviewed for assessment of PAD in patients naive for any prior revascularisation of lower-limb arteries. All DSA studies were read by two senior physicians blinded to outcome, and consensus was reached in cases of disagreement. RAS was defined as the presence of ≥50% stenosis in either renal artery. Patients' electronic medical files were systematically reviewed and follow-up was completed by contact with family physicians until January 2014. The primary outcome was composite, including death, peripheral revascularisation, or any limb amputation. Secondary outcomes were all-cause mortality, and another composite, including death and non-fatal myocardial infarction or stroke or coronary or carotid revascularisation. RESULTS: In total, 400 consecutive patients having a first DSA of lower extremities, two thirds of whom were for critical limb ischaemia, were studied. Thirteen patients were excluded owing to poor renal artery imaging. RAS was detected in 57 patients (14%). Only two factors were independently and significantly associated with RAS in multivariate analysis: diffuse PAD (involving both proximal and distal segments [odds ratio {OR} 3.50, 95% confidence interval {CI} 1.16-10.54; p = .026]) and decreased glomerular filtration rate (OR 0.55 per 30 mL/minute/1.73 m2, 95% CI 0.41-0.75; p < .001). During follow-up (mean ± SD 62 ± 47 months), 25% experienced limb amputation and 54% died. In multivariate analysis, no significant association was found between RAS and primary outcome (hazard ratio 0.80; 95% CI 0.57-1.10). No significant association was found with secondary outcomes. CONCLUSION: Incidental RAS is frequent (14%) among patients with PAD undergoing lower extremity imaging. No difference in outcome in patients with RAS versus those without RAS was seen. Larger studies are necessary to draw definite conclusions.


Assuntos
Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/epidemiologia , Obstrução da Artéria Renal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Amputação , Angiografia Digital , Feminino , França/epidemiologia , Humanos , Achados Incidentais , Estimativa de Kaplan-Meier , Salvamento de Membro , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/terapia , Prevalência , Prognóstico , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/mortalidade , Obstrução da Artéria Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
16.
Med Clin North Am ; 101(1): 65-79, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27884236

RESUMO

Renal artery disease produces a spectrum of progressive clinical manifestations ranging from minor degrees of hypertension to circulatory congestion and kidney failure. Moderate reductions in renal blood flow do not induce tissue hypoxia or damage, making medical therapy for renovascular hypertension feasible. Several prospective trials indicate that optimized medical therapy using agents that block the renin-angiotensin system should be the initial management. Evidence of progressive disease and/or treatment failure should allow recognition of high-risk subsets that benefit from renal revascularization. Severe reductions in kidney blood flow ultimately activate inflammatory pathways that do not reverse with restoring blood flow alone.


Assuntos
Hipertensão/diagnóstico , Hipertensão/terapia , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/terapia , Angioplastia , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/etiologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Sistema Renina-Angiotensina , Stents
17.
BMC Nephrol ; 17(1): 198, 2016 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-27927187

RESUMO

BACKGROUND: Identification of patients at risk of developing adverse events would enable aggressive medical therapy and possibly targeted revascularization. The aim of this study is to characterize the determinants of long-term outcomes in atherosclerotic renovascular disease (ARVD). METHODS: Patients with a radiological diagnosis of ARVD were recruited into this single-center prospective cohort study between 1986 and 2014. Data collected included baseline co-morbid conditions, annualized prescribed medications and laboratory data (serum creatinine [υmol/L], proteinuria [g/24 h]). Multivariable Cox regression analysis was used to explore association with these end-points: death, end-stage kidney disease (ESKD), cardiovascular event (CVE) and the first of any of these events. RESULTS: A total of 872 patients were recruited into this study. However, 42 patients were excluded due to missing baseline data and hence case records for 830 patients were reviewed. Over median follow-up of 57.1 months (interquartile range: 21.7-96.9), incidence per 100 patient years of death, ESKD, CVE and any event was 13.5, 4.2, 8.9 and 21.0 respectively. Macrovascular disease (MVD), congestive heart failure (CHF), flash pulmonary oedema (FPE) and greater proteinuria at baseline were individually associated with increased risk for all end-points in multivariable analysis (Death: MVD -HR 1.24 [95% CI 1.02-1.50]; CHF -HR 1.33 [95% CI 1.08-1.64]; FPE - HR 2.10 [95% CI 1.50-2.92]; proteinuria - HR 1.14 [95% CI 1.08-1.20]). Higher estimated glomerular filtration rate at time of diagnosis was significantly associated with reduced risk of all end-points (Death: HR 0.92 [95% CI 0.89-0.94])., Administration of statins and renin angiotensin blockade (RAB) at baseline were also associated with reduced adverse events, especially death (RAB: HR 0.83 [95% CI 0.70-0.98]; statins: HR 0.79 [95% CI 0.66-.94]) and ESKD (RAB: HR 0.84 [95% CI 0.71-1.00]; statins: HR 0.79 [95% CI 0.66-0.93]). Revascularization was associated with reduced risk of death (HR 0.65 [95% CI 0.51-0.83]) and ESKD (HR 0.59 [95% CI 0.46-0.76]). CONCLUSION: All patients with ARVD require intensive vascular protection therapy to help mitigate systemic atherosclerosis, optimize cardiovascular risk and improve clinical outcomes. More effort is required to identify the minority of patients who may benefit from revascularization.


Assuntos
Doenças Cardiovasculares/epidemiologia , Falência Renal Crônica/epidemiologia , Proteinúria/epidemiologia , Edema Pulmonar/epidemiologia , Obstrução da Artéria Renal/epidemiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Fatores Etários , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aterosclerose/complicações , Aterosclerose/epidemiologia , Aterosclerose/cirurgia , Doenças Cardiovasculares/mortalidade , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/epidemiologia , Prognóstico , Estudos Prospectivos , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/cirurgia , Fatores de Risco
18.
Hypertension ; 68(5): 1145-1152, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27647847

RESUMO

Randomized clinical trials have not shown an additional clinical benefit of renal artery stent placement over optimal medical therapy alone. However, studies of renal artery stent placement have not examined the relationship of albuminuria and treatment group outcomes. The CORAL study (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) is a prospective clinical trial of 947 participants with atherosclerotic renal artery stenosis randomized to optimal medical therapy with or without renal artery stent which showed no treatment differences (3(5.8% and 35.1% event rate at mean 43-month follow-up). In a post hoc analysis, the study population was stratified by the median baseline urine albumin/creatinine ratio (n=826) and analyzed for the 5-year incidence of the primary end point (myocardial infarction, hospitalization for congestive heart failure, stroke, renal replacement therapy, progressive renal insufficiency, or cardiovascular disease- or kidney disease-related death), for each component of the primary end point, and overall survival. When baseline urine albumin/creatinine ratio was ≤ median (22.5 mg/g, n=413), renal artery stenting was associated with significantly better event-free survival from the primary composite end point (73% versus 59% at 5 years; P=0.02), cardiovascular disease-related death (93% versus 85%; P≤ 0.01), progressive renal insufficiency (91% versus 77%; P=0.03), and overall survival (89% versus 76%; P≤0.01), but not when baseline urine albumin/creatinine ratio was greater than median (n=413). These data suggest that low albuminuria may indicate a potentially large subgroup of those with renal artery stenosis that could experience improved event-free and overall-survival after renal artery stent placement plus optimal medical therapy compared with optimal medical therapy alone. Further research is needed to confirm these preliminary observations. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00081731.


Assuntos
Albuminúria/epidemiologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/terapia , Stents , Vasodilatadores/administração & dosagem , Idoso , Albuminúria/diagnóstico , Albuminúria/terapia , Comorbidade , Intervalos de Confiança , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Obstrução da Artéria Renal/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
19.
J Hypertens ; 34(7): 1407-15, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27065003

RESUMO

OBJECTIVE: Percutaneous transluminal renal angioplasty (PTA) is one of the standard treatments for renal artery stenosis (RAS). We investigated the frequency and risk factors for restenosis, and its impact on blood pressure (BP) control. METHODS: A total of 175 hypertensive patients with RAS [mean age 60 years; 34% women; 30.3% fibromuscular dysplasia (FMD)] with 207 treated renal arteries were included and followed for more than 1 year without reangioplasty. Diagnosis of restenosis was based on duplex ultrasonographic findings, and data including BP and antihypertensive medication were collected consecutively. RESULTS: During follow-up (mean, 5.1 years), 56 patients (32.0%) developed restenosis. In multivariate Cox regression analysis, FMD was an independent predictor of restenosis (hazard ratio 2.65, P < 0.05). When divided into two groups based on FMD or atherosclerotic RAS (ARAS), the presence of previous cardiovascular disease (hazard ratio 2.84) as well as severe RAS (≥90%) (hazard ratio 3.95) in ARAS were independent predictors of restenosis (P < 0.05, respectively). At 1 year after PTA, 35 patients (20.0%) had developed restenosis. When divided into four groups on the basis of FMD or ARAS, and the absence/presence of restenosis at 1 year, the number of antihypertensive drugs was significantly lower in both FMD and ARAS patients without restenosis (P < 0.01, respectively); however, a significant difference in decrease in SBP (-31 ±â€Š19 vs. -12 ±â€Š25 mmHg, P < 0.05) as well as cure of hypertension (36.4 vs. 5.0%, P < 0.01) between the absence/presence of restenosis was found only in FMD patients. CONCLUSION: The frequency of restenosis after renal PTA is significant, and the presence of restenosis diminishes the benefit of its treatment, especially for FMD.


Assuntos
Arteriosclerose/complicações , Pressão Sanguínea , Displasia Fibromuscular/epidemiologia , Hipertensão/fisiopatologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Anti-Hipertensivos/uso terapêutico , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/cirurgia , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
20.
Transplant Proc ; 48(1): 74-80, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26915846

RESUMO

BACKGROUND: Transplant renal artery stenosis (TRAS), the most common vascular complication after transplant (Tx), leads to resistant hypertension, impaired renal function, and even loss of the graft. The purpose of the study was to investigate the prevalence and factors associated with TRAS in northeastern Brazil. METHODS: The study was conducted as a retrospective case-control study in a population of Tx recipients in a renal Tx center in northeastern Brazil. Demographic and clinical characteristics of the recipients and donors, data related to the surgery, laboratory data, and number of anti-hypertensive drugs were assessed. Statistical analysis was performed with the use of SPSS 17.0. RESULTS: A total of 494 of 529 recipients were assessed, of which 24 had TRAS. The prevalence of TRAS was 4.8%. Twelve patients (50%) were men with a mean age of 46.7 ± 13.5 years. The mean time of diagnosis was 89.9 days after Tx. The risk factors associated with TRAS were number of anti-hypertensive drugs ≥2 (odds ratio, 17.0; confidence interval, 4.1 to 70.4; P = .001) and grafting with 2 or more arteries (odds ratio, 8.9; confidence interval, 1.4 to 56.6; P = .021). There was a significant reduction in mean systolic blood pressure (147.1 ± 23.7 to 127.8 ± 15.2 mm Hg, P = .001) and diastolic blood pressure (86.6 ± 13.0 to 77.6 ± 9.4 mm Hg, P = .001) after TRAS repair and in serum creatinine (2.8 ± 2.4 to 1.9 ± 1.8 mg/dL, P = .04). CONCLUSIONS: Grafts with 2 or more arteries are associated with TRAS, as well as patients who use a higher number of anti-hypertensive drugs. TRAS repair was associated with improved blood pressure control and renal function.


Assuntos
Oclusão de Enxerto Vascular/etiologia , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/etiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Rim/irrigação sanguínea , Rim/cirurgia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/fisiopatologia , Insuficiência Renal/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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