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.
Background. The purpose of this study was to evaluate retrospectively the clinical context and ef... more Background. The purpose of this study was to evaluate retrospectively the clinical context and effectiveness of arterial percutaneous transluminal angioplasty (PTA) of arterio-venous fistulae in chronic haemodialysis patients. Methods. Between May 1992 and June 1997, arterial PTA was performed in 33 patients with a total of 35 angioaccess devices of the upper limbs (18 arterio-venous fistulae and 17 PTFE grafts). Clinical indications for arterial PTA were unexplained acute thrombosis in 12 patients (34.3%), insufficient blood flow in 13 patients (37.1%), and severe limb ischaemia in 10 patients (28.6%), two of whom had skin ulcerations and one had severe neurological damage. Follow-up periods varied between 1 and 55 months (mean 15.5 months). Results. PTA was attempted in 22 radial, 10 brachial and seven ulnar arteries. Angioplasty was successful (i.e. residual stenosis of O30%) in all but one patient. There were no complications. Early re-thrombosis (-1 month) occurred in two of the 12 patients with acute occlusions. All the angioaccesses of patients with insufficient blood flow were improved. Eight of the patients with limb ischaemia became symptom free, and two were failures (one had partial healing of skin ulcerations and one did not improve). Re-stenosis occurred in six cases (27.3% of the 22 angiograms performed) but re-dilatation was performed in only two instances. Primary and secondary patencies were 63.5 and 90.6% at 6 months and 40.8 and 75.6% at 24 months, respectively. Conclusion. Chronic arterial lesions in upper limbs bearing vascular access devices for haemodialysis may lead to thrombosis, ischaemia and insufficient flow for dialysis treatment. PTA is a safe and effective technique with a low rate of re-intervention.
Journal of the American Society of Nephrology, 2001
The general use of bilateral rather than separate renal function evaluation has led to the public... more The general use of bilateral rather than separate renal function evaluation has led to the publication of conflicting results concerning the effect of percutaneous transluminal renal angioplasty (PTRA) on renal function, especially in patients with atherosclerotic renal artery stenosis. The aim of this study was to evaluate prospectively, in standardized conditions, split renal function (SRF) and GFR outcome after successful PTRA, by measuring single kidney GFR with synchronous inulin or 51 Cr-ethylenediaminetetraacetic acid clearance and 99m Tc-diethylenetriamine pentaacetic acid scintigraphy, in a well-defined population of patients with unilateral renal artery stenosis. Thirty-two consecutive hypertensive patients (18 with atherosclerotic and 14 with dysplastic disease) with significant unilateral stenosis of the main native renal artery (Ն60%) and normal renal function were included in the study. Renal and angiographic follow-up evaluations were performed 6 mo after PTRA. PTRA alone or combined with stenting (n ϭ 2) was technically successful in all patients. Repeat PTRA was necessary in two patients, evaluated 6 mo after the second PTRA. Six mo after PTRA, total GFR had increased slightly but significantly in the 29 patients with positive lateralization indices. SRF and single-kidney GFR of the stenotic kidney increased significantly, whereas concurrently the GFR and SRF of the nonstenotic kidney decreased significantly. Six mo after successful PTRA reducing renal ischemia, a reversal of both the hypoperfusion of the stenotic side and the hyperperfusion of the nonstenotic side was observed, which was accompanied by a slight increase in total GFR.
Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We repo... more Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We report here a case in which we applied a new diagnostic method to assess the efficacy of distal radial ligation to treat this syndrome. A favorable comparison of distal radial artery pressure measurements before and after temporary occlusion of the artery with a balloon catheter indicated that perfusion of the hand would be dramatically improved after surgical artery ligation.
Catheterization and Cardiovascular Diagnosis, 1993
A case of traumatic arteriovenous fistula and false aneurysm of the internal mammary artery was e... more A case of traumatic arteriovenous fistula and false aneurysm of the internal mammary artery was encountered following sternal wire insertion during cardiac surgery. The diagnosis was suspected by echodoppler and confirmed by arteriography allowing percutaneous embolization using cyanoacrylate in the same setting.
repeated clinical examination showed an access with no thrill perceptible and two flat aneurysms.... more repeated clinical examination showed an access with no thrill perceptible and two flat aneurysms. When the arm was set in pronation, angioaccess thrilled normally anew. An angiogram revealed that the access was patent without significant stenosis. A retrograde puncture of the brachial artery at the elbow was then performed to analyze the arterial tree of the forearm. Frames were taken in both the pronated and supinated positions. The radial artery was occluded. The ulnar artery was normally patent in pronation but occluded in supination because of an external compression just below its takeoff (Figs 1 and 2). Magnetic resonance imaging was also performed and revealed that the ulnar artery was compressed in a flexor digitorum fibrosous arcade ("sublimis bridge"), which is a slip connecting the flexor digitorum superficialis and profundus muscles. Underneath this anomalous structure lay the ulnar artery. Because of the two large aneurysms on the PTFE graft (Fig 2, A)
The Editors invite readers to submit letters commenting on the contents of articles that appear i... more The Editors invite readers to submit letters commenting on the contents of articles that appear in the JOURNAL, Also welcome are brief communications in letter form reporting investigative or clinical observations without extensive documentation and with brief bibliography (five titles or less), not requiring peer review but open to critique by readers. Letters to the Editors should be no more than 500 words in length and they may have to be edited for publication.
All surgical methods published to date for the reduction of excessive high-flow in native elbow f... more All surgical methods published to date for the reduction of excessive high-flow in native elbow fistulas for dialysis have limitations. We report a new surgical approach to flow reduction by transposition of the radial artery to the elbow level. Methods: From 1992 to 2008, 47 consecutive patients (22 women) with brachial artery to elbow vein autogenous fistula underwent flow reduction via replacement of brachial artery by transposed distal radial artery inflow. Fistulas were side-to-end either brachial-cephalic (19) or brachial-basilic (28). The indications were hand ischemia (4), cardiac failure (13), concerns about future cardiac dysfunction (23), and chronic venous hypertension resulting in aneurysmal degeneration of the vein (7). Mean patient age was 44 years, 11% were diabetic, 17% were smokers, and mean BMI was 22. Mean fistula age before flow reduction was 2.5 years. Results: Technical success was 91% (43 of 47). The mean flow rate dropped by 66% ؎ 14%. Clinical success in symptomatic patients was 75% (18 of 24). The fistula eventually had to be ligated in three cases of cardiac failure because of insufficient clinical improvement. All four patients with hand ischemia were cured, with no recurrence during follow-up. Primary patency rates at one and three years were 61% ؎ 7% and 40% ؎ 8%. Secondary patency rates at one and three years were 89% ؎ 5% and 70% ؎ 8%. Conclusion: Transposition of the radial artery, a safe and effective technique, might now be considered in the surgical armamentarium of flow reduction techniques.
Journal of Vascular and Interventional Radiology, 2009
PURPOSE: To report long-term clinical and morphologic results after stent placement for spontaneo... more PURPOSE: To report long-term clinical and morphologic results after stent placement for spontaneous renal artery dissection (SRAD). MATERIALS AND METHODS: Between 1991 and 2006, 16 consecutive patients (13 men; mean age, 42 y ؎ 12) presented with SRAD in 17 arteries. All patients had uncontrolled hypertension at the time of presentation. Nine patients had lower back pain, 10 had progressive renal insufficiency, and three had both. All patients underwent renal angiography and stent implantation. They were followed up clinically and with renal imaging. RESULTS: Baseline blood pressure and plasma creatinine levels were 176/107 mm Hg and 142 mol/L, respectively. Successful renal artery recanalization and stent implantation were achieved in all patients. After a mean follow-up of 8.6 years ؎ 3.4, mean blood pressure was 118/78 mm Hg, with Seven patients were taking no antihypertensive medication, with five and four patients taking single or double antihypertensive agents, respectively. The most recent follow-up showed that plasma creatinine levels were normal, and imaging of the renal arteries showed no sign of restenosis or occlusion in all patients. CONCLUSIONS: Stent implantation for symptomatic SRAD is an effective treatment in the long term and represents a safe alternative to surgery.
Journal of Vascular and Interventional Radiology, 1996
To report midterm follow-up after implantation of covered stents for hemodialysis access. Over a ... more To report midterm follow-up after implantation of covered stents for hemodialysis access. Over a 2-year period, a Cragg Endopro stent was placed in 14 patients (mean age, 66.6 years +/- 15) to treat angioplasty-induced ruptures (n = 3), pseudoaneurysm (n = 1), postangioplasty residual stenosis (n = 2), and early restenosis (n = 8, four of them in a Wallstent). Initial placement was successful in all cases. A clinical inflammatory reaction was observed in all three cases of placement in the forearm. When the covered stent was placed in a stenotic vessel, restenosis always occurred within 6 months. Primary and secondary patencies were 28.5% +/- 13.9 and 67.8% +/- 14.5, respectively, at 6 months. Covered stents were of undoubtable benefit in one case of rupture after Wallstent failure and in one case of restenosis in a Wallstent. Covered Cragg stents are effective in controlling angioplasty- induced rupture and sometimes for maintaining patency after restenosis in a Wallstent. They do not prevent restenosis and are responsible for an inflammatory reaction of unknown origin and long-term effect.
The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a n... more The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a native renal artery and the clinical and angiographic variables that may influence its occurrence were studied in 104 hypertensive patients. Angiograms obtained immediately before and after angioplasty and, in 92 patients, 8.8 +/- 6.0 months after angioplasty were interpreted separately by two observers. Stenosis severity was classified into five grades, and restenosis was defined by a stenosis one grade or more higher at follow-up than immediately after angioplasty. Interobserver concordance for etiology, stenosis grade, and other angiographic items yielded kappa coefficients in the range of 0.328-0.942. Sessions were organized to reach a consensus in each case. Ostial stenoses were more frequent in patients with atheromatous stenoses, and branch stenoses were more frequent in those with fibromuscular dysplasia. There was no significant difference between the 15 patients (16%) with reste...
Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncont... more Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncontrolled studies. The aim of this study was to document the efficacy and safety of angioplasty for lowering blood pressure in patients with atherosclerotic renal artery stenosis. Patients were randomly assigned antihypertensive drug treatment (control group, nϭ26) or angioplasty (nϭ23). Twenty-four-hour ambulatory blood pressure, the primary end point, was measured at baseline and at termination. Termination took place 6 months after randomization or earlier in patients who developed refractory hypertension. In those allocated angioplasty, antihypertensive treatment was discontinued after the procedure but was subsequently resumed if hypertension persisted. Secondary end points were the treatment score and the incidence of complications. Two patients in the control group and 6 in the angioplasty group suffered procedural complications (relative risk, 3.4; 95% confidence interval, 0.8 to 15.1). Early termination was required for refractory hypertension in 7 patients in the control group. Antihypertensive treatment was resumed in 17 patients in the angioplasty group. Mean ambulatory blood pressure at termination did not differ between control (141Ϯ15/84Ϯ11 mm Hg) and angioplasty (140Ϯ15/81Ϯ9 mm Hg) groups. Angioplasty reduced by 60% the probability of having a treatment score of 2 or more at termination (relative risk, 0.4; 95% confidence interval, 0.2 to 0.7). There was 1 case of dissection with segmental renal infarction and 3 of restenosis in the angioplasty group. No patient suffered renal artery thrombosis. In unilateral atherosclerotic renal artery stenosis, angioplasty is a drug-sparing procedure that involves some morbidity. Previous uncontrolled and unblinded assessments of angioplasty overestimated its potential for lowering blood pressure.
Sixty-four thrombosed hemodialysis fistulas in 55 patients were treated by local low-dose infusio... more Sixty-four thrombosed hemodialysis fistulas in 55 patients were treated by local low-dose infusion of urokinase, percutaneous angioplasty, and thromboaspiration. Lysis was initially successful in 38 cases (59%) without any negative side effects. At 1 year, 59% of these fistulas were still functional. When the procedures failed, surgery saved the vascular access in 17 cases. Local fibrinolysis combined with thromboaspiration and angioplasty provides a clinically useful means of access preservation.
We report the case of a 50-year-old man who presented to our institution with septic thrombosis o... more We report the case of a 50-year-old man who presented to our institution with septic thrombosis of the renal vein which had not resolved despite several days of antibiotic therapy. Optimal restoration of renal vein flow was obtained by percutaneous manual aspiration embolectomy (PMAE) in this patient with contraindication to fibrinolytic therapy and surgery.
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.
Background. The purpose of this study was to evaluate retrospectively the clinical context and ef... more Background. The purpose of this study was to evaluate retrospectively the clinical context and effectiveness of arterial percutaneous transluminal angioplasty (PTA) of arterio-venous fistulae in chronic haemodialysis patients. Methods. Between May 1992 and June 1997, arterial PTA was performed in 33 patients with a total of 35 angioaccess devices of the upper limbs (18 arterio-venous fistulae and 17 PTFE grafts). Clinical indications for arterial PTA were unexplained acute thrombosis in 12 patients (34.3%), insufficient blood flow in 13 patients (37.1%), and severe limb ischaemia in 10 patients (28.6%), two of whom had skin ulcerations and one had severe neurological damage. Follow-up periods varied between 1 and 55 months (mean 15.5 months). Results. PTA was attempted in 22 radial, 10 brachial and seven ulnar arteries. Angioplasty was successful (i.e. residual stenosis of O30%) in all but one patient. There were no complications. Early re-thrombosis (-1 month) occurred in two of the 12 patients with acute occlusions. All the angioaccesses of patients with insufficient blood flow were improved. Eight of the patients with limb ischaemia became symptom free, and two were failures (one had partial healing of skin ulcerations and one did not improve). Re-stenosis occurred in six cases (27.3% of the 22 angiograms performed) but re-dilatation was performed in only two instances. Primary and secondary patencies were 63.5 and 90.6% at 6 months and 40.8 and 75.6% at 24 months, respectively. Conclusion. Chronic arterial lesions in upper limbs bearing vascular access devices for haemodialysis may lead to thrombosis, ischaemia and insufficient flow for dialysis treatment. PTA is a safe and effective technique with a low rate of re-intervention.
Journal of the American Society of Nephrology, 2001
The general use of bilateral rather than separate renal function evaluation has led to the public... more The general use of bilateral rather than separate renal function evaluation has led to the publication of conflicting results concerning the effect of percutaneous transluminal renal angioplasty (PTRA) on renal function, especially in patients with atherosclerotic renal artery stenosis. The aim of this study was to evaluate prospectively, in standardized conditions, split renal function (SRF) and GFR outcome after successful PTRA, by measuring single kidney GFR with synchronous inulin or 51 Cr-ethylenediaminetetraacetic acid clearance and 99m Tc-diethylenetriamine pentaacetic acid scintigraphy, in a well-defined population of patients with unilateral renal artery stenosis. Thirty-two consecutive hypertensive patients (18 with atherosclerotic and 14 with dysplastic disease) with significant unilateral stenosis of the main native renal artery (Ն60%) and normal renal function were included in the study. Renal and angiographic follow-up evaluations were performed 6 mo after PTRA. PTRA alone or combined with stenting (n ϭ 2) was technically successful in all patients. Repeat PTRA was necessary in two patients, evaluated 6 mo after the second PTRA. Six mo after PTRA, total GFR had increased slightly but significantly in the 29 patients with positive lateralization indices. SRF and single-kidney GFR of the stenotic kidney increased significantly, whereas concurrently the GFR and SRF of the nonstenotic kidney decreased significantly. Six mo after successful PTRA reducing renal ischemia, a reversal of both the hypoperfusion of the stenotic side and the hyperperfusion of the nonstenotic side was observed, which was accompanied by a slight increase in total GFR.
Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We repo... more Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We report here a case in which we applied a new diagnostic method to assess the efficacy of distal radial ligation to treat this syndrome. A favorable comparison of distal radial artery pressure measurements before and after temporary occlusion of the artery with a balloon catheter indicated that perfusion of the hand would be dramatically improved after surgical artery ligation.
Catheterization and Cardiovascular Diagnosis, 1993
A case of traumatic arteriovenous fistula and false aneurysm of the internal mammary artery was e... more A case of traumatic arteriovenous fistula and false aneurysm of the internal mammary artery was encountered following sternal wire insertion during cardiac surgery. The diagnosis was suspected by echodoppler and confirmed by arteriography allowing percutaneous embolization using cyanoacrylate in the same setting.
repeated clinical examination showed an access with no thrill perceptible and two flat aneurysms.... more repeated clinical examination showed an access with no thrill perceptible and two flat aneurysms. When the arm was set in pronation, angioaccess thrilled normally anew. An angiogram revealed that the access was patent without significant stenosis. A retrograde puncture of the brachial artery at the elbow was then performed to analyze the arterial tree of the forearm. Frames were taken in both the pronated and supinated positions. The radial artery was occluded. The ulnar artery was normally patent in pronation but occluded in supination because of an external compression just below its takeoff (Figs 1 and 2). Magnetic resonance imaging was also performed and revealed that the ulnar artery was compressed in a flexor digitorum fibrosous arcade ("sublimis bridge"), which is a slip connecting the flexor digitorum superficialis and profundus muscles. Underneath this anomalous structure lay the ulnar artery. Because of the two large aneurysms on the PTFE graft (Fig 2, A)
The Editors invite readers to submit letters commenting on the contents of articles that appear i... more The Editors invite readers to submit letters commenting on the contents of articles that appear in the JOURNAL, Also welcome are brief communications in letter form reporting investigative or clinical observations without extensive documentation and with brief bibliography (five titles or less), not requiring peer review but open to critique by readers. Letters to the Editors should be no more than 500 words in length and they may have to be edited for publication.
All surgical methods published to date for the reduction of excessive high-flow in native elbow f... more All surgical methods published to date for the reduction of excessive high-flow in native elbow fistulas for dialysis have limitations. We report a new surgical approach to flow reduction by transposition of the radial artery to the elbow level. Methods: From 1992 to 2008, 47 consecutive patients (22 women) with brachial artery to elbow vein autogenous fistula underwent flow reduction via replacement of brachial artery by transposed distal radial artery inflow. Fistulas were side-to-end either brachial-cephalic (19) or brachial-basilic (28). The indications were hand ischemia (4), cardiac failure (13), concerns about future cardiac dysfunction (23), and chronic venous hypertension resulting in aneurysmal degeneration of the vein (7). Mean patient age was 44 years, 11% were diabetic, 17% were smokers, and mean BMI was 22. Mean fistula age before flow reduction was 2.5 years. Results: Technical success was 91% (43 of 47). The mean flow rate dropped by 66% ؎ 14%. Clinical success in symptomatic patients was 75% (18 of 24). The fistula eventually had to be ligated in three cases of cardiac failure because of insufficient clinical improvement. All four patients with hand ischemia were cured, with no recurrence during follow-up. Primary patency rates at one and three years were 61% ؎ 7% and 40% ؎ 8%. Secondary patency rates at one and three years were 89% ؎ 5% and 70% ؎ 8%. Conclusion: Transposition of the radial artery, a safe and effective technique, might now be considered in the surgical armamentarium of flow reduction techniques.
Journal of Vascular and Interventional Radiology, 2009
PURPOSE: To report long-term clinical and morphologic results after stent placement for spontaneo... more PURPOSE: To report long-term clinical and morphologic results after stent placement for spontaneous renal artery dissection (SRAD). MATERIALS AND METHODS: Between 1991 and 2006, 16 consecutive patients (13 men; mean age, 42 y ؎ 12) presented with SRAD in 17 arteries. All patients had uncontrolled hypertension at the time of presentation. Nine patients had lower back pain, 10 had progressive renal insufficiency, and three had both. All patients underwent renal angiography and stent implantation. They were followed up clinically and with renal imaging. RESULTS: Baseline blood pressure and plasma creatinine levels were 176/107 mm Hg and 142 mol/L, respectively. Successful renal artery recanalization and stent implantation were achieved in all patients. After a mean follow-up of 8.6 years ؎ 3.4, mean blood pressure was 118/78 mm Hg, with Seven patients were taking no antihypertensive medication, with five and four patients taking single or double antihypertensive agents, respectively. The most recent follow-up showed that plasma creatinine levels were normal, and imaging of the renal arteries showed no sign of restenosis or occlusion in all patients. CONCLUSIONS: Stent implantation for symptomatic SRAD is an effective treatment in the long term and represents a safe alternative to surgery.
Journal of Vascular and Interventional Radiology, 1996
To report midterm follow-up after implantation of covered stents for hemodialysis access. Over a ... more To report midterm follow-up after implantation of covered stents for hemodialysis access. Over a 2-year period, a Cragg Endopro stent was placed in 14 patients (mean age, 66.6 years +/- 15) to treat angioplasty-induced ruptures (n = 3), pseudoaneurysm (n = 1), postangioplasty residual stenosis (n = 2), and early restenosis (n = 8, four of them in a Wallstent). Initial placement was successful in all cases. A clinical inflammatory reaction was observed in all three cases of placement in the forearm. When the covered stent was placed in a stenotic vessel, restenosis always occurred within 6 months. Primary and secondary patencies were 28.5% +/- 13.9 and 67.8% +/- 14.5, respectively, at 6 months. Covered stents were of undoubtable benefit in one case of rupture after Wallstent failure and in one case of restenosis in a Wallstent. Covered Cragg stents are effective in controlling angioplasty- induced rupture and sometimes for maintaining patency after restenosis in a Wallstent. They do not prevent restenosis and are responsible for an inflammatory reaction of unknown origin and long-term effect.
The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a n... more The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a native renal artery and the clinical and angiographic variables that may influence its occurrence were studied in 104 hypertensive patients. Angiograms obtained immediately before and after angioplasty and, in 92 patients, 8.8 +/- 6.0 months after angioplasty were interpreted separately by two observers. Stenosis severity was classified into five grades, and restenosis was defined by a stenosis one grade or more higher at follow-up than immediately after angioplasty. Interobserver concordance for etiology, stenosis grade, and other angiographic items yielded kappa coefficients in the range of 0.328-0.942. Sessions were organized to reach a consensus in each case. Ostial stenoses were more frequent in patients with atheromatous stenoses, and branch stenoses were more frequent in those with fibromuscular dysplasia. There was no significant difference between the 15 patients (16%) with reste...
Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncont... more Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncontrolled studies. The aim of this study was to document the efficacy and safety of angioplasty for lowering blood pressure in patients with atherosclerotic renal artery stenosis. Patients were randomly assigned antihypertensive drug treatment (control group, nϭ26) or angioplasty (nϭ23). Twenty-four-hour ambulatory blood pressure, the primary end point, was measured at baseline and at termination. Termination took place 6 months after randomization or earlier in patients who developed refractory hypertension. In those allocated angioplasty, antihypertensive treatment was discontinued after the procedure but was subsequently resumed if hypertension persisted. Secondary end points were the treatment score and the incidence of complications. Two patients in the control group and 6 in the angioplasty group suffered procedural complications (relative risk, 3.4; 95% confidence interval, 0.8 to 15.1). Early termination was required for refractory hypertension in 7 patients in the control group. Antihypertensive treatment was resumed in 17 patients in the angioplasty group. Mean ambulatory blood pressure at termination did not differ between control (141Ϯ15/84Ϯ11 mm Hg) and angioplasty (140Ϯ15/81Ϯ9 mm Hg) groups. Angioplasty reduced by 60% the probability of having a treatment score of 2 or more at termination (relative risk, 0.4; 95% confidence interval, 0.2 to 0.7). There was 1 case of dissection with segmental renal infarction and 3 of restenosis in the angioplasty group. No patient suffered renal artery thrombosis. In unilateral atherosclerotic renal artery stenosis, angioplasty is a drug-sparing procedure that involves some morbidity. Previous uncontrolled and unblinded assessments of angioplasty overestimated its potential for lowering blood pressure.
Sixty-four thrombosed hemodialysis fistulas in 55 patients were treated by local low-dose infusio... more Sixty-four thrombosed hemodialysis fistulas in 55 patients were treated by local low-dose infusion of urokinase, percutaneous angioplasty, and thromboaspiration. Lysis was initially successful in 38 cases (59%) without any negative side effects. At 1 year, 59% of these fistulas were still functional. When the procedures failed, surgery saved the vascular access in 17 cases. Local fibrinolysis combined with thromboaspiration and angioplasty provides a clinically useful means of access preservation.
We report the case of a 50-year-old man who presented to our institution with septic thrombosis o... more We report the case of a 50-year-old man who presented to our institution with septic thrombosis of the renal vein which had not resolved despite several days of antibiotic therapy. Optimal restoration of renal vein flow was obtained by percutaneous manual aspiration embolectomy (PMAE) in this patient with contraindication to fibrinolytic therapy and surgery.
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