Renal artery stenosis surgery: Difference between revisions
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(/* 2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT){{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, H...) |
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*Use of aortic grafts as bypass graft | *Use of aortic grafts as bypass graft | ||
== | ==2013 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref>== | ||
===Surgery (DO NOT EDIT)<ref name=" | ===Surgery (DO NOT EDIT)<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117 }} </ref>=== | ||
{|class="wikitable" | {|class="wikitable" | ||
Revision as of 15:35, 7 January 2014
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Renal artery stenosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Renal artery stenosis surgery On the Web |
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American Roentgen Ray Society Images of Renal artery stenosis surgery |
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Risk calculators and risk factors for Renal artery stenosis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian, Vishnu Vardhan Serla M.B.B.S. [2], Karol Gema Hernandez, M.D. [3]
Overview
Both balloon angioplasty and surgery have equal rates of cure in terms of improving kidney function and hypertension in patients with renal artery stenosis (RAS). Therefore, taking into consideration the complications associated with the vascular surgical reconstruction, angioplasty is the preferred first-line treatment of RAS requiring an intervention.[1] Vascular surgical reconstruction is reserved for a minority of cases. The need for reoperation is documented in 5-15% of all RAS patients who require surgical intervention.
Surgery
Vascular surgical reconstruction is reserved for a minority of cases. Similar to all surgeries, vascular surgical reconstruction is associated with complications. The need for reoperation is documented in 5-15% of all RAS patients who require surgical intervention.[2][3][4][5][6]
Indications
Vascular surgical reconstruction is indicated in specific cases of atherosclerotic RAS[2][3][4][5][6]:
- Involvement of multiple small arteries
- Involvement of early primary branching of the main renal artery
- Renal artery reconstruction during pararenal aortic reconstruction in cases such as aortic aneurysms or aortoiliac occlusive disease
Risk Factors
It is important to note that vascular surgical reconstruction of the renal arteries may be complicated by associated risks. The risk of complications increases in the following conditions[2][3][4][5][6]:
- Concomitant aortic reconstruction
- Renal insufficiency
- Use of aortic grafts as bypass graft
2013 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)[7]
Surgery (DO NOT EDIT)[7]
| Class I |
| "1. Vascular surgical reconstruction is indicated for patients with fibromuscular dysplastic RAS with clinical indications for interventions (same as for PTA), especially those exhibiting complex disease that extends into the segmental arteries and those having macroaneurysms. (Level of Evidence: B)" |
| "2. Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS and clinical indications for intervention, especially those with multiple small renal arteries or early primary branching of the main renal artery. (Level of Evidence: B)" |
| "3. Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS in combination with pararenal aortic reconstructions (in treatment of aortic aneurysms or severe aortoiliac occlusive disease). (Level of Evidence: C)" |
References
- ↑ Dworkin LD, Cooper CJ (2009). "Clinical practice. Renal-artery stenosis". N Engl J Med. 361 (20): 1972–8. doi:10.1056/NEJMcp0809200. PMID 19907044.
- ↑ 2.0 2.1 2.2 Novick AC (1988). "Surgical correction of renovascular hypertension". Surg Clin North Am. 68 (5): 1007–25. PMID 3051450.
- ↑ 3.0 3.1 3.2 Cambria RP, Brewster DC, L'Italien GJ, Moncure A, Darling RC, Gertler JP; et al. (1994). "The durability of different reconstructive techniques for atherosclerotic renal artery disease". J Vasc Surg. 20 (1): 76–85, discussion 86-7. PMID 8028093.
- ↑ 4.0 4.1 4.2 Novick AC, Ziegelbaum M, Vidt DG, Gifford RW, Pohl MA, Goormastic M (1987). "Trends in surgical revascularization for renal artery disease. Ten years' experience". JAMA. 257 (4): 498–501. PMID 3795433.
- ↑ 5.0 5.1 5.2 Libertino JA, Bosco PJ, Ying CY, Breslin DJ, Woods BO, Tsapatsaris NP; et al. (1992). "Renal revascularization to preserve and restore renal function". J Urol. 147 (6): 1485–7. PMID 1593670.
- ↑ 6.0 6.1 6.2 Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC (1995). "Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery". J Vasc Surg. 21 (6): 926–33, discussion 934. PMID 7776472.
- ↑ 7.0 7.1 Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.