L’hematome dissequant spontane des arteres renales (HDSAR) est une affection rare dont 1’incidenc... more L’hematome dissequant spontane des arteres renales (HDSAR) est une affection rare dont 1’incidence reste meconnue. II survient chez le sujet jeune, le plus souvent de sexe masculin. Sa presentation clinique habituelle, sous forme d’une triade, est celle d’une douleur lombaire brutale de type colique nephretique. Elle est associee a une hypertension arterielle (HTA) grave et d’installation rapide. Parfois, une insuffisance renale inaugurale est associee. L’hematurie microscopique est inconstante. A cette triade, s’associe un syndrome inflammatoire, souvent modere.
10 mg/day bisoprolol, 120 mg/day urapidil, 5 mg/day amlodipine and 1 mg/day guanfacine). The righ... more 10 mg/day bisoprolol, 120 mg/day urapidil, 5 mg/day amlodipine and 1 mg/day guanfacine). The right brachial blood pressure was 212/94 mmHg and blood pressure in the left arm was 192/99 mmHg. There was
... Lancet 1987; ii: 1313-1316. PubMed. a Department of Hypertension, Hôpital Broussais, 75645, P... more ... Lancet 1987; ii: 1313-1316. PubMed. a Department of Hypertension, Hôpital Broussais, 75645, Paris, France. b Department of Cardiovascular Radiology, Hôpital Broussais, 75645, Paris, France. c Department of Medical Informatics ...
Journal of Vascular and Interventional Radiology, 1998
PURPOSE: To report the immediate results and the clinical and angiographic outcome of percutaneou... more PURPOSE: To report the immediate results and the clinical and angiographic outcome of percutaneous angioplasty in patients with ostial renal artery stenosis.
Journal of Vascular and Interventional Radiology, 1994
The authors report their experience with implantation of self-expandable stents into renal arteri... more The authors report their experience with implantation of self-expandable stents into renal arteries. Twenty-five Wallstent endoprostheses were deployed into 18 renal arteries in 18 patients. Atheroma was the cause of the initial renal artery lesion in 15 patients (four ostial, 10 postostial, and one long occlusion). In these 15 patients, indications for stent placement were 12 immediate failures of percutaneous transluminal renal angioplasty (PTRA), two immediate PTRA complications (dissections), and one recurrent stenosis. The other renal artery lesions were three dissections (two spontaneous and one after catheterization). The procedure was technically successful in all patients, with residual stenosis less than 20%. However, five stents were slightly misplaced and a second stent was implanted to fully cover the lesion. Three complications occurred: one acute thrombosis 15 days after stent implantation that was successfully treated with local fibrinolysis, one asymptomatic occlusion due to early thrombosis or to delayed restenosis, and one segmental renal infarction related to extensive dissection after PTRA and not to stent placement. Following stent implantation, systolic blood pressure (P = .006) and diastolic blood pressure (P = .002) measured at 6 months decreased significantly. Angiographic follow-up was obtained in 16 patients (with intravenous technique in nine and intraarterial digital subtraction angiography in seven) at a mean of 11 months after stent placement, and ultrasonographic follow-up was obtained in the two others after 8 and 25 months, respectively. A normal patent renal artery was demonstrated in 16 patients (89%); there was one restenosis with a 75% reduction in diameter of the renal artery and the asymptomatic occlusion above mentioned. Self-expandable stent implantation is a promising technique in PTRA failures. Wallstent placement is technically feasible. Immediate results were satisfactory and the midterm restenosis rate was low in this series of patients.
Journal of Vascular and Interventional Radiology, 2001
Recent articles reported excellent results in the percutaneous declotting of native fistulas for ... more Recent articles reported excellent results in the percutaneous declotting of native fistulas for hemodialysis with use of thromboaspiration, mechanical devices, or thrombolytic drugs, with success rates ranging from 76% to 100%. These results challenge the surgical approach, the effectiveness of which is not supported by comparable publications. Although it is more difficult to declot forearm native fistulas than grafts, declotting of fistulas is more rewarding because it achieves better long-term patency (1-year primary rates as high as 50% and secondary rates of 80%). The results reported from declotting of fistulas in the upper arm are not as good. The unmasking of stenoses in close to 100% of cases warrants stenosis detection programs similar to those used for grafts.
The Journal of Clinical Endocrinology & Metabolism, 2012
Context: Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is l... more Context: Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in patients with primary aldosteronism. However, this procedure is invasive, poorly standardized, and not widely available. Objective: Our goal was to identify patients' characteristics that can predict unilateral aldosterone hypersecretion in some patients who could hence bypass adrenal venous sampling before surgery. Design and Setting: A cross-sectional diagnostic study was performed from February 2009 to July 2010 at a single center specialized in hypertension care. Patients: A total of 101 consecutive patients with primary aldosteronism who underwent adrenal venous sampling participated in the study. The autonomy of aldosterone hypersecretion was assessed with the saline infusion test. Intervention: Adrenal venous sampling was performed without ACTH infusion but with simultaneous bilateral sampling. Main Outcome Measures: Variables independently associated with a late...
... But Not Infrequent Disease! Olivier Pellerin Æ Bernard Beyssen Æ Alain Raynaud Æ Marc Sapoval... more ... But Not Infrequent Disease! Olivier Pellerin Æ Bernard Beyssen Æ Alain Raynaud Æ Marc Sapoval ... 4. Paris B, Bobrie G, Rossignol P, Le Coz S, Chedid A, Plouin PF (2006) Blood pressure and renal outcomes in patients with kidney infarction and hypertension. ...
This study analyzed the initial presentation and revascularization outcomes of patients with radi... more This study analyzed the initial presentation and revascularization outcomes of patients with radiation-induced renal artery stenosis, a rare complication of therapeutic irradiation. Of 11 patients with renal artery stenosis after irradiation, 7 patients fulfilled the following criteria: normotension before irradiation, radiation dose greater than 25 grays delivered to the renal arteries, associated perirenal radiation-induced lesions, and absence of arterial disease outside the radiation field. The median age at irradiation was 30 years, and the median local irradiation dose was 40 grays. The median time from irradiation to referral was 13 years. All patients were hypertensive at referral, with a median blood pressure (BP) of 171/102 mm Hg and median treatment score of two. The median glomerular filtration rate was 67 mL/min. Two patients had bilateral stenoses and 1 patient had stenosis affecting a single kidney. Stenoses were proximal in 6 patients and truncal in 1 patient, and all had the appearance of atherosclerotic stenosis. Percutaneous transluminal renal artery angioplasty (PTRA) was successful in 5 patients, but required multiple insufflations. PTRA failed in 1 patient, who subsequently underwent an aortorenal bypass. After a median follow-up of 36 months, 2 patients had died of noncardiovascular causes and 4 patients remained hypertensive, with a median BP of 136/85 mm Hg and median treatment score of two. No restenosis occurred, but aneurysms developed at the site of angioplasty in 1 patient. If hypertension occurs even decades after irradiation, a radiation-induced renal artery stenosis should be sought in patients who have undergone abdominal irradiation.
Results and Long-Term Follow-up1 Percutaneous transluminal angioplasty (PTA) was used to treat 10... more Results and Long-Term Follow-up1 Percutaneous transluminal angioplasty (PTA) was used to treat 109 patients with 141 renal artery stenoses, including 58 patients in whom medical management was unsuccessful. The initial success rate was 94%. Fifty-five patients had severe diffuse atherosclerosis and 40 had renal insufficiency. Thus far, 36 patients (50 stenoses) have undergone a total of 52 follow-up angiographic studies. Clinical data, including blood pressure response, were obtained in all cases. Only 7 of the 98 hypertensive patients failed to respond to PTA. Of the 11 patients treated primarily for renal insufficiency, 5 improved. Of the 29 hypertensive patients who also had elevated BUN and creatinine, renal function improved in 13. Altogether, 96 patients (88%) benefited from the procedure. Analysis of long-term resuits suggests that PTA should be the treatment of choice for fibromuscular dysplasia and short, segmental atherosclerotic lesions and could also prove helpful in improving renal insufficiency.
L’hematome dissequant spontane des arteres renales (HDSAR) est une affection rare dont 1’incidenc... more L’hematome dissequant spontane des arteres renales (HDSAR) est une affection rare dont 1’incidence reste meconnue. II survient chez le sujet jeune, le plus souvent de sexe masculin. Sa presentation clinique habituelle, sous forme d’une triade, est celle d’une douleur lombaire brutale de type colique nephretique. Elle est associee a une hypertension arterielle (HTA) grave et d’installation rapide. Parfois, une insuffisance renale inaugurale est associee. L’hematurie microscopique est inconstante. A cette triade, s’associe un syndrome inflammatoire, souvent modere.
10 mg/day bisoprolol, 120 mg/day urapidil, 5 mg/day amlodipine and 1 mg/day guanfacine). The righ... more 10 mg/day bisoprolol, 120 mg/day urapidil, 5 mg/day amlodipine and 1 mg/day guanfacine). The right brachial blood pressure was 212/94 mmHg and blood pressure in the left arm was 192/99 mmHg. There was
... Lancet 1987; ii: 1313-1316. PubMed. a Department of Hypertension, Hôpital Broussais, 75645, P... more ... Lancet 1987; ii: 1313-1316. PubMed. a Department of Hypertension, Hôpital Broussais, 75645, Paris, France. b Department of Cardiovascular Radiology, Hôpital Broussais, 75645, Paris, France. c Department of Medical Informatics ...
Journal of Vascular and Interventional Radiology, 1998
PURPOSE: To report the immediate results and the clinical and angiographic outcome of percutaneou... more PURPOSE: To report the immediate results and the clinical and angiographic outcome of percutaneous angioplasty in patients with ostial renal artery stenosis.
Journal of Vascular and Interventional Radiology, 1994
The authors report their experience with implantation of self-expandable stents into renal arteri... more The authors report their experience with implantation of self-expandable stents into renal arteries. Twenty-five Wallstent endoprostheses were deployed into 18 renal arteries in 18 patients. Atheroma was the cause of the initial renal artery lesion in 15 patients (four ostial, 10 postostial, and one long occlusion). In these 15 patients, indications for stent placement were 12 immediate failures of percutaneous transluminal renal angioplasty (PTRA), two immediate PTRA complications (dissections), and one recurrent stenosis. The other renal artery lesions were three dissections (two spontaneous and one after catheterization). The procedure was technically successful in all patients, with residual stenosis less than 20%. However, five stents were slightly misplaced and a second stent was implanted to fully cover the lesion. Three complications occurred: one acute thrombosis 15 days after stent implantation that was successfully treated with local fibrinolysis, one asymptomatic occlusion due to early thrombosis or to delayed restenosis, and one segmental renal infarction related to extensive dissection after PTRA and not to stent placement. Following stent implantation, systolic blood pressure (P = .006) and diastolic blood pressure (P = .002) measured at 6 months decreased significantly. Angiographic follow-up was obtained in 16 patients (with intravenous technique in nine and intraarterial digital subtraction angiography in seven) at a mean of 11 months after stent placement, and ultrasonographic follow-up was obtained in the two others after 8 and 25 months, respectively. A normal patent renal artery was demonstrated in 16 patients (89%); there was one restenosis with a 75% reduction in diameter of the renal artery and the asymptomatic occlusion above mentioned. Self-expandable stent implantation is a promising technique in PTRA failures. Wallstent placement is technically feasible. Immediate results were satisfactory and the midterm restenosis rate was low in this series of patients.
Journal of Vascular and Interventional Radiology, 2001
Recent articles reported excellent results in the percutaneous declotting of native fistulas for ... more Recent articles reported excellent results in the percutaneous declotting of native fistulas for hemodialysis with use of thromboaspiration, mechanical devices, or thrombolytic drugs, with success rates ranging from 76% to 100%. These results challenge the surgical approach, the effectiveness of which is not supported by comparable publications. Although it is more difficult to declot forearm native fistulas than grafts, declotting of fistulas is more rewarding because it achieves better long-term patency (1-year primary rates as high as 50% and secondary rates of 80%). The results reported from declotting of fistulas in the upper arm are not as good. The unmasking of stenoses in close to 100% of cases warrants stenosis detection programs similar to those used for grafts.
The Journal of Clinical Endocrinology & Metabolism, 2012
Context: Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is l... more Context: Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in patients with primary aldosteronism. However, this procedure is invasive, poorly standardized, and not widely available. Objective: Our goal was to identify patients' characteristics that can predict unilateral aldosterone hypersecretion in some patients who could hence bypass adrenal venous sampling before surgery. Design and Setting: A cross-sectional diagnostic study was performed from February 2009 to July 2010 at a single center specialized in hypertension care. Patients: A total of 101 consecutive patients with primary aldosteronism who underwent adrenal venous sampling participated in the study. The autonomy of aldosterone hypersecretion was assessed with the saline infusion test. Intervention: Adrenal venous sampling was performed without ACTH infusion but with simultaneous bilateral sampling. Main Outcome Measures: Variables independently associated with a late...
... But Not Infrequent Disease! Olivier Pellerin Æ Bernard Beyssen Æ Alain Raynaud Æ Marc Sapoval... more ... But Not Infrequent Disease! Olivier Pellerin Æ Bernard Beyssen Æ Alain Raynaud Æ Marc Sapoval ... 4. Paris B, Bobrie G, Rossignol P, Le Coz S, Chedid A, Plouin PF (2006) Blood pressure and renal outcomes in patients with kidney infarction and hypertension. ...
This study analyzed the initial presentation and revascularization outcomes of patients with radi... more This study analyzed the initial presentation and revascularization outcomes of patients with radiation-induced renal artery stenosis, a rare complication of therapeutic irradiation. Of 11 patients with renal artery stenosis after irradiation, 7 patients fulfilled the following criteria: normotension before irradiation, radiation dose greater than 25 grays delivered to the renal arteries, associated perirenal radiation-induced lesions, and absence of arterial disease outside the radiation field. The median age at irradiation was 30 years, and the median local irradiation dose was 40 grays. The median time from irradiation to referral was 13 years. All patients were hypertensive at referral, with a median blood pressure (BP) of 171/102 mm Hg and median treatment score of two. The median glomerular filtration rate was 67 mL/min. Two patients had bilateral stenoses and 1 patient had stenosis affecting a single kidney. Stenoses were proximal in 6 patients and truncal in 1 patient, and all had the appearance of atherosclerotic stenosis. Percutaneous transluminal renal artery angioplasty (PTRA) was successful in 5 patients, but required multiple insufflations. PTRA failed in 1 patient, who subsequently underwent an aortorenal bypass. After a median follow-up of 36 months, 2 patients had died of noncardiovascular causes and 4 patients remained hypertensive, with a median BP of 136/85 mm Hg and median treatment score of two. No restenosis occurred, but aneurysms developed at the site of angioplasty in 1 patient. If hypertension occurs even decades after irradiation, a radiation-induced renal artery stenosis should be sought in patients who have undergone abdominal irradiation.
Results and Long-Term Follow-up1 Percutaneous transluminal angioplasty (PTA) was used to treat 10... more Results and Long-Term Follow-up1 Percutaneous transluminal angioplasty (PTA) was used to treat 109 patients with 141 renal artery stenoses, including 58 patients in whom medical management was unsuccessful. The initial success rate was 94%. Fifty-five patients had severe diffuse atherosclerosis and 40 had renal insufficiency. Thus far, 36 patients (50 stenoses) have undergone a total of 52 follow-up angiographic studies. Clinical data, including blood pressure response, were obtained in all cases. Only 7 of the 98 hypertensive patients failed to respond to PTA. Of the 11 patients treated primarily for renal insufficiency, 5 improved. Of the 29 hypertensive patients who also had elevated BUN and creatinine, renal function improved in 13. Altogether, 96 patients (88%) benefited from the procedure. Analysis of long-term resuits suggests that PTA should be the treatment of choice for fibromuscular dysplasia and short, segmental atherosclerotic lesions and could also prove helpful in improving renal insufficiency.
Uploads
Papers by Alain Raynaud