González VD, Rodríguez TJM, Rodríguez RN, Téllez EA, Chaires CJ, Castellanos RDK

Language: Spanish
References: 22
Page: 60-71
PDF size: 54.91 Kb.

ABSTRACT

Renovascular hypertension is the most frequent cause of secondary hypertension, occurs as a result of stenosis of the renal artery or one of its main branches, in 90% of cases are due to atherosclerosis and the rest are rare causes such as Takayasu’s arteritis and fibromuscular dysplasia. The natural history of renal artery stenosis, is associated with a significant morbidity and mortality, and its necessary to be suspected as a cause of hypertension, especially in patients at risk, because it is a potentially treatable cause of hypertension. Indications for revascularization include greater than 60% stenosis associated with difficult to control hypertension, sudden pulmonary edema, congestive heart failure, hypertensive crisis, renal function impairment associated with the intake of inhibitors of angiotensin converting enzyme, chronic renal failure associated with bilateral stenosis and/or in the presence of solitary kidney. Endovascular treatment has not been scientifically proven its utility in ateroesclerotic disease, however in cases of systemic vasculitis and fibromuscular dysplasia is the first line treatment. Currently, clinical studies have not shown that the results of surgery are superior to medical treatment, so there are in development prospective randomized trials for proper evaluation of the results in order to make appropriate treatment decisions.

REFERENCES

1. Grewal P. Renal Artery Stenosis. Vasc Endovasc Surg Highligths 2009-2010.

2. Connolly JO. Renovascular hypertension: diagnosis and management. BJU Int 2005; 95.

3. White R. Vascular surgery, basic science and clinical correlations. 2nd. Ed. Massachusetts, USA: Blackwell Publishing; 2005, p. 639.

4. Hirsch AT. ACC/AHA Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). J Am College Cardiol 2006; XX(X).

5. Curry TK. Fibromuscular dysplasia: When is Intervention Warranted? Sem Vasc Surg 2003; 16(3).

6. Textor SC. Renovascular hypertension in 2007: Where are we now? Current Cardiol Rep 2007; 9(6).

7. Hallet J. Comprehensive vascular and endovascular surgery. España: Editorial Mosby; 2004, p. 712.

8. Crutchley TA. Clinical utility of the resistive index in atherosclerotic renovascular disease. J Vasc Surg 2009; 49(1).

9. Kerut KE. Atheroesclerotic renal artery stenosis and renovascular hypertension: Clinical diagnosis and indications for revascularization. J Clin Hypert 2006; 8(7).

10. Ziakka S. Predictive factors and therapeutic approach of renovascular disease: four year follow up. Renal Failure 2008; 30: 965-70.

11. Pearce JD. Progression of atherosclerotic renovascular disease: a prospective population-based study. J Vasc Surg 2006;44(5).

12. Norgren L. Inter-Society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33: S1eS70.

13. Edwards MS. Contemporary management of atherosclerotic renovascular disease. J Vasc Surg 2009; 50: 1197-210.

14. Knipp BS. Diffusion of new technology for the treatment of renovascular hypertension in the United States: Surgical revascularization versus catheter-based therapy, 1988-2001. J Vasc Surg 2004; 40(4).

15. Nolan BW. Outcomes of renal artery angioplasty and stenting using low-profile systems. J Vasc Surg 2005; 41(1).

16. Edwards MS. Distal embolic protection during renal artery angioplasty and stenting. J Vasc Surg 2006; 44(1).

17. Weaver FA. Renal revascularization in Takayasu arteritisinduced renal artery stenosis. J Vasc Surg 2004; 39(4).

18. Textor SC. Current approaches to renovascular hypertension. Med Clin N Am 2009; 93: 717-32.

19. Thomas KC. Fibromuscular dysplasia: When is intervention warranted? Sem Vasc Surg 2003; 16(3).

20. Tanemoto M. Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular displasia. J Vasc Surg 2005; 41(5).

21. Elliot WJ. Renovascular hypertension: An update. J Clin Hypert 2008; 10(7).

22. Grigoryants V. Iliorenal bypass: Indications and outcomes following 41 reconstructions. Ann Vasc Surg 2007; 21(1).