Abstract: Renal artery stenosis is a common condition that can cause renovascular hypertension or ischemic nephropathy. Endovascular treatment for atherosclerotic renal artery stenosis is performed frequently and its usage has rapidly increased during the last few years. However clinical benefit of renal artery stenting is questionable. Many researchers suppose that clinical outcomes after renal artery stenting may be improved. Several potential ways to this improvement is discussed: the evaluation of hemodinamical parameters of the stenosis, viability of the renal tissue, prophylactic of the atheroembolisation and restenosis. This article reviews the recent data concerning perspective trends in endovascular procedures on renal arteries that can improve long-term clinical outcomes after renal artery stenting. References 1. Wheatley K., Phil D., Ives N. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med. 2009; 36: 1953 - 62. 2. Textor S. Despite results from ASTRAL, jury still out on stenting for atherosclerotic renal artery stenosis. Nephrology. Times .2010; 3: 2-7. 3. Kapoor N., Fahsah I., Karim R et al. Physiological assessment of renal artery stenosis: comparisons of resting with hyperemic renal pressure measurements. Catheter. Cardiovasc. Interv. 2010; 76(5): 726-32. 4. Rundback J.H., Sacks D., Kent K.C., et al. Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. Circulation. 2002; 106: 1572-1585. 5. Jones N., Bates E., Chetcuti S. Usefulness of tran- slesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease. Catheter. Cardiovasc. Interv. 2006; 68(3): 429-34. 6. Mitchell J., Subramanian R., White C. et al. Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: renal fractional flow reserve. Catheter. Cardiovasc. Interv. 2007; 69(5):685-9. 7. Kadziela J., Witkowski A., Januszewicz A. Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography. BloodPress. 2011; 20(4): 211-7. 8. Drieghe B., Madaric J., Sarno G. et al. Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. European. Heart. Journal. 2007; 29 (4): 517-24. 9. Subramanian R., White C.J., Rosenfield K. et al. Renal fractional flow reserve: a hemodynamic evaluation of moderate renal artery stenoses. Catheter. Cardiovasc. Interv. 2005; 64: 480-486. 10. Leesar M., Varma J., Shapira A. Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography. J. Am. Coll. Cardiol. 2009; 53(25): 2363-71. 11. Radermacher J., Chavan A., Bleck J. et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N. Engl. J. Med. 2001; 344: 410-417. 12. Doi Y., Iwashima Y., Yoshihara F. Et al. Renal resistive index and cardiovascular and renal outcomes in essential hypertension. Hypertension. 2012; Jul 23. Epub ahead of print. 13. Zeller T., Ulrich F., Mflller C., Bbrgelin K., Sinn L. Angioplasty of severe atherosclerotic ostial renal artery stenosis: predictors of improved renal function after percutaneous stent-supported intervention. Circulation 2003; 108: 2244-2249. 14. Liew Y., Bartholomew J. Atheromatous embolization. hsc. Med. 2005; 10: 309-326. 15. Holden A. Is there an indication for embolic protection in renal artery intervention? Tech. Vasc. Interv. Radiol. 2011; 14(2): 95-100. 16. Rocha-Singh K., Eisenhauer A.,Textor S. Atherosclerotic peripheral vascular disease symposium II: intervention for renal artery disease. Circulation. 2008; 118: 2873-2878. 17. Feldman R., Wargovich T., Bittl J. No-touch technique for reducing aortic wall trauma during renal artery stenting. Catheter. Cardiovasc. Interv. 1999; 46(2): 245-8. 18. Kolluri R., Goldstein J., Rocha-Singh K. Percutaneous vascular interventions in renal artery diseases. Minerva. Cardioangiol. 2006; 54: 95-107. 19. Hiramoto J., Hansen K., Pan X. Atheroemboli during renal artery angioplasty: an ex vivo study. J. Vhsc. Surg. 2005; 41(6): 1026-30. 20. Holden A., Hill A. Renal angioplasty and stenting with distal protection of the main renal artery in ischemic nephropathy: early experience. Journal Vascular. Surgery. 2003; 38: 962-968. 21. Perkovic V., Thomson K., Mitchell P. et al. Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes. Austral. Radiol. 2001; 45: 438-43. 22. Paulsen D., Klow N., Rogstad B. et al. Preservation of renal function by percutaneous transluminal angioplasty in ischaemic renal disease. Nephrol. Dial Transplant. 1999; 14: 1454-61. 23. Leertouwer T., Gussenhoven E., Bosch J. et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000; 216: 78-85. 24. Vignali C., Bargellini I., Lazzereschi M. et al. Predictive factors of in-stent restenosis in renal artery stenting: a retrospective analysis. Cardiovasc. Intervent. Radiol. 2005; 28: 296-302. 25. Corriere M., Edwards M., Pearce J. et al. Restenosis after renal artery angioplasty and stenting: incidence and risk factors. J. Vasc. Surg. 2009; 50(4): 813-819. 26. Leertouwer T., Gussenhoven E., van Overhagen H. et al. Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound. J. Vasc. Interv. Radiol. 1998; 9: 945-952. 27. Zeller T., Rastan A., Rothenpieler U. et al. Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents? Catheter. Cardiovasc. Interv. 2006; 68(1): 125-30. 28. Sapoval M., Zghringer M., Pattynama P. et al. Low- profile stent system for treatment of atherosclerotic renal artery stenosis: the GREAT trial. J. Vasc. Intern Radiol. 2005; 16(9): 1195-202.
Modern approaches to the diagnosis and treatment of vasorenal hypertension Part II: clinical results of renal artery stenting
DOI: https://doi.org/10.25512/DIR.2012.06.2.11
For quoting:
Zyatenkov A.V., Shutikhina I.V., Kokov L.S. "Modern approaches to the diagnosis and treatment of vasorenal hypertension Part II: clinical results of renal artery stenting ". Journal Diagnostic & interventional radiology. 2012; 6(2); 95-100.
|
authors:
|
Article exists only in Russian.
Abstract: Purpose. Was to investigate ability of videodensitometry for assessment the effect of renal artery stenosis on parenchymal perfusion. Materials and methods. Аngiographic data of 97 patients with and 55 patients without renal artery stenosis were analyzed by means of videodensitometry, using «Multivox» software. All patients underwent renal arteries duplex ultrasound and kidneys ultrasound examination. Levels of blood pressure and kidney function as a clinical signs of renovascular hypertension were assessed. Risk factors of kidney parenchymal injury such as diabetes mellitus, chronic kidney diseases were monitored. Results. Videodensitometric analysis allows to detect statistically significant differences in parenchymal perfusion between kidneys with and without renal artery stenosis. A grade of changes in parenchymal perfusion correlates with angiographicaly measured degree of renal artery stenosis and renal artery blood flow velocity. Conclusion. Videodensitometric perfusion parameters can be used to assess the effect of renal artery stenosis on parenchymal blood flow. Thus, videodensitometry extends diagnostic capability of angiographic study. References 1. Hansen K.J. et al. Prevalence of renovascular desease in eldery. А populaton based study. J. Vasc. Surg. 2002; 36: 443–451. 2. Safian R.D., Textor S.C. Renal artery stenosis. N. Engl. J. Med. 2001; 344: 431–442. 3. Rihal C.S. et al. Incedental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. May. Clin. Proc. 2002; 77:309–316. 4. Olin J.W. et al. Prevalence of atherosclerotic RAS in patients with atherosclerosis else-where. Am. J. Med. 1990; 88: 46–51. 5. Galaria I.I. et al. Percutaneous and open renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surgery. 2005; 19 (2): 218–228.
6. Weibull H. et al. Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis. А prospective randomized study.J. Vasc. Surg. 1993; 18: 841–850. 7. Murphy T.P. et al. Increase of utilization of percutaneous renal artery interventions. Am.J. of Roentgenol. 2004; 183: 561–568. 8. Wheatley K. et al. Revascularization versus medical therapy for renal artery stenosis. N.Engl. J. Med. 2009; 361: 1953–1962. 9. Rocha-Singh K.J. et al. Atherosclerotic Peripheral Vascular Disease Symposium II: Intervention for Renal Artery Disease. Circulation. 2008; 118: 2873–2878. 10. Волынский Ю.Д., Кириллов М.Г., Шамалов Н.А. и др. Анализ экстра- и интракраниальной гемодинамики с помощью метода рентгеноденситометрии. Спец. выпуск «Инсульт». Ж. невр. и псих. им. С.С.Корсакова. 2007; 243. 11. Meier P., Zierler K.L. On the theory of the indicator-dilution method for measurement of blood flow and volume. J. Appl. Physiol. 1954; 12: 731–744.
|
keywords:
|
Abstract: Aneurism of the splenic artery is a rare, but potentially life-threatening condition. In the majority of patients with an aneurism of unpaired visceral arteries the endovascular procedure is a treatment of choice. Of them stent graft implantation is considered as the most promising method. However, until recent only balloon-dilated stent grafts were used. Due to a rigid delivering system this type of grafts cannot be implanted in distal branches of visceral arteries, that is significant limitation of this technique. Technological advances and developing of low-profile soft self-expanding grafts allow overcoming this limitation. New type of grafts opens the possibility to exclude aneurisms even in conditions of marked vessel tortuosity and complex vascular anatomy Conclusion: stent-graft implantation is an effective and safe method of treatment of splenic artery false aneurisms. This method allows to reliably exclude an aneurism from the circulation and is not associated with increased risk of thrombotic complications. Modern low-profile soft self-expanding grafts open new possibility in treatment of visceral arteries aneurisms even in conditions of marked vessel tortuosity and complex vascular anatomy. References 1. Pokrovskij A.V. Zabolevanija aorty i ee vetvej. M. Medicina. 1979; 324 [In Russ]. 2. Nosher J.L., Chung J., Brevetti L.S. et al. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. RadioGraphics. 2006; 26: 1687-1704. 3. Hossain A., Reis E.D., Dave S.P. et al. Visceral artery aneurysms: experience in a tertiary-care center. Am Surgr. 2001; 67(5): 432-437. 4. Stanley J.C., Fry W.J. Pathogenesis and clinical significance of splenic artery aneurysms. Surgery. 1974; 76: 898-899. 5. Messina L.M., Shanley C.J. Visceral artery aneurysms. Surg. Clin. North. Am. 1997; 77: 425-442. 6. Meng WC.S., Chan M., Lau W.Y., Li A.K.C. Splanchnic aneurysms. H. K M. J 1995; 1(2): 173-177. 7. Lai R., Mallery S. Primary splenic artery aneurysm diagnosed by EUS. Visible Human Journal of Endosonography. 2002; 4(1): 2-3. 8. Kemmeter P., Bonnell B., VanderKolk W. et al. Percutaneous thrombin injection of splanchnic artery aneurysms: two case reports. J. Vasc. Interv. Radiol. 2000; 11(4): 469-472. 9. Kasirajan K., Greenberg R.K., Clair D., Ouriel K. Endovascular management of visceral artery aneurysm. J. Endovasc. Ther. 2001; 8: 150-155. 10. Janzen R.M., Simpson W.T. Visceral artery aneurysm. C. J. S. - 2004; 43(4): 301-302. 11. Ikeda O., Tamura Y., Nakasone Y. et al. Coil embolization of pancreaticoduodenal artery aneurysms associated with coeliac artery stenosis: report of three cases. Cardiovasc. Intern Radiol. 2007; 30: 504-507. 12. Chino O., Kijama H., Shibuya M. et al. A case report: spontaneous rupture of dissecting aneurysm of the middle colic artery. Tokai. J. Exp. Clin. Med. 2004; 29(4): 155-158. 13. Babadzhanov B.R., Husainov B.R., Juldashev G.Ju. Anevrizma selezenochnoj arterii kak prichina segmentarnoj vnepechenochnoj portal'noj gipertenzii [Splenic artery aneurism as a cause of anhepatic segmentary portal hypertension]. Klinicheskaja hirurgija. 1989; 9: 62-63 [In Russ]. 14. Gavrilenko A.V. Hirurgicheskoe lechenie hronicheskoj abdominal'noj ishemii: Dis. dokt. med. nauk. M., 1990 [In Russ]. 15. Lishenko A.N., Ermakov E.A., Shalaginov S.I., Gofman A.V. Razryv anevrizmy selezenochnoj arterii [Splenic artery aneurism rupture]. Hirurgija. 2005; 7: 58-59 [In Russ]. 16. Pokrovskij A.V. Klinicheskaja angiologija: Rukovodstvo v 2-h tomah. M. Medicina. 2004;2: 117-128 [In Russ]. 17. Stanley J.C., Wakefield T.W., Graham L.M. et al. Clinical importance and management of splanchnic artery aneurysms. J. Vasc. Surg. 1986; 3: 836-840. 18. Tochii M., Ogino H., Sasaki H. et al. Successful surgical treatment for aneurysm of splenic artery with anomalous origin. Ann. Thorac. Cardiovasc. Surg. 2005; 11(5). 346-349. 19. Wagner W.H., Allins A.D., Treiman R.L. et al. Ruptured visceral artery aneurysms. Ann. Vasc. Surg. 1997; 11(4): 342-347. 20. Weber C.H., Pfeifer K.J., Tato F. et al. Transcatheter coil embolization of an aneurysm of the pancreatico-duodenal artery with occluded celiac trunk. Cardiovasc. Intern Radiol. 2005; 2: 259-261. 21. Karaman K., Onat L., Sirvanci M., Olga R. Endovascular stent graft treatment in a patient with splenic artery aneurysm. Diagn. Interv. Radiol. 2005; 11: 119-121. 22. Jibiki M., Inoue Y., Iwai T. et al. Treatment of three pancreaticoduodenal artery aneurysms associated with coeliac artery occlusion and splenic artery aneurysm: a case report and review of the literature Eur. J. Vasc. Endovasc. Surg. 2005; 29(2): 213-217. 23. Porcu P., Marongiu G.M., Bacciu P.P. Aneurysms of the celiac artery: case report and review of the literature . J. Mal. Vasc. 2002; 27(2): 88-92. 24. Pulcini G., D’Adda F., Lanzi S. et al. Aneurysms of the superior mesenteric artery. Ann. Ital. Chir. 2002; 73(2): 129-136. 25. Sakai H., Urasawa K., Oyama N., Kitabatake A. Successful covering of a hepatic artery aneurysm with a coronary stent-graft. Cardiovasc. Interv. Radiol. 2004; 27: 274-277. 26. Duncan A.A. Median arcuate ligament syndrome. Curr. Treat. Options. Cardiovasc. Med. 2008; 10(2): 112-116. 27. Gandini R., Pipitone V., Konda D. et al. Endovascular treatment of a giant superior mesenteric artery pseudoaneurysm using a nitinol stent-graft. Cardiovasc. Interv. Radiol. 2005;1: 102-106. 28. Grego F.G., Lepidi S., Ragazzi R. et al. Visceral artery aneurysms: a single center experience. Cardiovasc. Surg. 2003; 11(1): 19-25. 29. Troickij A.V., Bobrovskaja A.N., Orehov PJu. i dr. Uspeshnoe chreskozhnoe jendovaskuljarnoe lechenie razryva anevrizmy bedrennoj arterii [Succesfull endovascular treatment femoral artery aneurism rupture]. Angiologija i sosudistaja hirurgija. 2005; 11(1): 53-57 [In Russ]. 30. Chen F., Kriegshauser L.S., Huettl E.A., Roberts C.C. Percutaneous thrombin injection for treatment of a splenic artery aneurysm. Radiology. 2006; 1(1): 13-16. 31. Cope C., Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection . A.J.R 1986; 147: 383-387. 32. Guillon R., Garcier J.M., Abergel A. et al. Management of splenic artery aneurysms and false aneurysms with endovascular treatment in 12 patients . Cardiovasc. Interv. Radiol. 2003; 26: 256-260. 33. Jenssen G.L., Wirsching J., Pedersen G. et al. Treatment of a hepatic artery aneurysm by endovascular stent-grafting. Cardiovasc. Interv. Radiol. 2007; 30: 523-525. 34. Hyun-Ki Y., Mats L., Petr U. et al. Stent-graft repair of a splenic artery aneurysm. Cardiovasc. Interv. Radiol. 2001; 24: 200-203. 35. Garg A., Banait S., Babhad S. et al. Endovascular treatment of pseudoaneurysm of the common hepatic artery with intra-aneurysmal glue (N-butyl 2-cyanoacrylate) embolization. Cardiovasc. Intern Radiol. 2007; . 30: 999-1002. 36. Gabelmann A., Gorich J., Merkle E.M. Endovascular treatment of visceral artery aneurysm J. Endovasc. Ther. 2002; 9: 38-47.
|
authors:
|
Article exists only in Russian.
Article exists only in Russian.
Article exists only in Russian.
