1
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Drieghe B, Hendrickx I, De Buyzere M, De Backer T. Double kiss mini-crush technique to treat complex recurrent renal artery in-stent restenosis. Catheter Cardiovasc Interv 2024. [PMID: 38686525 DOI: 10.1002/ccd.31066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/23/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
The double-kiss mini-crush (DKMC) technique has been successfully deployed in the past for the treatment of complex coronary lesions even for left main lesions. Our case report consists of a proof-of-principle that the DKMC technique can be successfully translated as well to the field of complex renal artery lesions. Insightful thinking out-of-the "coronary" box in concert with skillful off-label application of coronary stenting procedures may open the gate for unprecedented opportunities for the treatment of difficult-to-tackle in-stent restenosis in the renal circulation.
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Affiliation(s)
- Benny Drieghe
- Heart Center, University Hospital Gent, Gent, Belgium
| | - Ief Hendrickx
- Heart Center, University Hospital Gent, Gent, Belgium
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2
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Yu MS, Xiang K, Haller ST, Cooper CJ. Renal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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3
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Abstract
Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes. Guideline-directed medical therapy is advised in all patients. Patients with refractory symptoms and hemodynamically significant stenoses are more likely to benefit from renal artery stent placement. Chronic mesenteric ischemia (CMI) is an infrequent and difficult to diagnose illness. Due to robust collateralization, clinical symptoms from mesenteric artery stenosis or occlusion is uncommon. Atherosclerosis is the most common etiology of CMI. Current evidence suggests that, compared with open surgical repair, endovascular therapy is the most cost-effective choice for CMI.
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Affiliation(s)
- Tamunoinemi Bob-Manuel
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Center, Ochsner Medical Center, The Ochsner Clinical School, University of Queensland, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Christopher J White
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Center, Ochsner Medical Center, The Ochsner Clinical School, University of Queensland, 1514 Jefferson Highway, New Orleans, LA 70121, USA; Department of Cardiology, Ochsner Medical Center, 3rd Floor, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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4
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Rosławiecka A, Kabłak-Ziembicka A, Badacz R, Rzeźnik D, Pieniążek P, Trystuła M, Przewłocki T. Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:65-75. [PMID: 32368238 PMCID: PMC7189135 DOI: 10.5114/aic.2019.91309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/21/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Restenosis (RS) following percutaneous angioplasty (PTA) of renal artery stenosis (RAS) might have an unfavourable impact on renal function and blood pressure (BP) outcomes. AIM To evaluate the prevalence and predictors of RS in patients treated with PTA for RAS, and the relationship between BP and renal function (RF) changes with RS. MATERIAL AND METHODS We analysed freedom from RS in 210 patients (age 64.6 ±12.8 years; range: 20-85), who underwent 248 successful stent-assisted PTAs in RAS. The change in levels of serum creatinine (SCC), estimated glomerular filtration rate (eGFR), systolic/diastolic BPs (SBP/DBP) were analysed prior to PTA, at 6-, 12-month, and final follow-up visits, and whenever RS was diagnosed. RESULTS RS was identified in 30 (14.3%) patients, and there were 36 (14.5%) lesions. The Kaplan-Meier RS-free survival curves in fibromuscular dysplasia, atherosclerosis, and vasculitis at 1 and 7 years were: 100% and 100%; 95.6 and 83.9%; and 71.4 and 39.7%, respectively. Patients with RS, as compared to RS-free patients, presented with less pronounced changes in respect with: SBP (1.4 ±17.6 vs. -15.8 ±25.8 mm Hg; p = 0.01), DBP (2.64 ±10.1 vs. -6.5 ±14.1 mm Hg; p = 0.002), SCC (22.4 ±55.2 vs. -3.6 ±43.9 µmol/l; p = 0.002), and eGFR (-1.85 ±18 vs. -5.34 ±19.5 mm Hg; p = 0.045). In multivariate Cox regression analysis, independent predictors of RS occurred: lack of BP decrease (HR = 4.19, 95% CI: 1.67-10.3; p = 0.002), eGFR increase < 0.17 ml/min/1.73 m2 (HR = 2.93, 95% CI: 1.08-7.91; p = 0.033), stent diameter ≤ 5 mm (HR = 2.76, 95% CI: 1.09-6.97; p = 0.031), and vasculitis (HR = 5.61, 95% CI: 1.83-17.2; p = 0.003). RS was treated in 24 patients with RS recurrence in 20%. CONCLUSIONS The RS rate differs depending on RAS aetiology. Lack of SBP/DBP and eGFR improvement, vasculitis, and stent diameter are associated with RS risk. Repeated PTA is effective, but recurrent RS occurs in 20% of cases.
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Affiliation(s)
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Rafał Badacz
- Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Daniel Rzeźnik
- Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Piotr Pieniążek
- Department of Diseases of Cardiac and Vessels, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery with Division of Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Tadeusz Przewłocki
- Department of Diseases of Cardiac and Vessels, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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5
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Chen Y, Dong H, Jiang X, Deng Y, Zou Y, Che W, Xiong H, Xu B, Yang Y, Gao R. Percutaneous transluminal angioplasty with selective stenting for the treatment of renal artery stenosis caused by fibromuscular dysplasia: 18 years' experience from the China Center for Cardiovascular Disease. Catheter Cardiovasc Interv 2020; 95 Suppl 1:641-647. [PMID: 31943685 DOI: 10.1002/ccd.28679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to evaluate the safety and efficiency of percutaneous transluminal angioplasty (PTA) with selective stenting treating Chinese patients with renal artery stenosis (RAS) due to fibromuscular dysplasia (FMD). BACKGROUND Endovascular data of patients with RAS caused by FMD are scarce in China. METHODS Clinical data of 105 hypertensive patients with RAS caused by FMD underwent endovascular therapy at a single-site between June 2001 and October 2018 were analyzed retrospectively. Baseline blood pressure, use of antihypertensive medications, renal function, and adverse events at a 1-year follow-up were evaluated. RESULTS The patients were aged between 10 and 64 years (mean age 26.7 ± 8.2 years) and 52 (49.5%) were female. In total, 105 patients undergoing endovascular therapy involving 124 RASs. Thirty (24.2%), sixty-four (51.6%), and thirty (24.2%) RASs were multifocal, unifocal, and tubular types, respectively. Ninety-four (89.5%) and eleven (10.5%) patients underwent PTA alone and PTA plus stenting, respectively. The technical success rate for endovascular therapy was 95.2% (100/105) without severe complications. During 1-year follow-up (n = 100), the mean systolic and diastolic blood pressure decreased from 157.6 ± 17.5 and 102.3 ± 14.2 to 129.6 ± 12.3 and 81.3 ± 11.1 mmHg, respectively, and the number of antihypertensive medications reduced from 2.2 ± 1.2 to 0.8 ± 1.0 (all p < .001). The cure rate and improved rate of blood pressure was 49.0 and 40.0%, respectively. The serum creatinine levels remained stable. The primary and secondary restenosis rate was 13.4 and 5.8%, respectively. CONCLUSION Endovascular therapy for treating RAS caused by FMD was technically safe and effective for reducing blood pressure in Chinese patients.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiongjing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Deng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wuqiang Che
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Xiong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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6
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Kapoor T, Oderich GS, DeMartino RR. Return of baseline kidney function after bilateral renal artery stent occlusion and treatment delay following fenestrated endografting. J Vasc Surg 2019; 70:262-266. [PMID: 30853383 DOI: 10.1016/j.jvs.2018.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
Although renal artery restenosis and thrombotic stent occlusion are not rare occurrences, the literature suggests that prompt diagnosis and treatment are essential to preserve renal function, particularly in the setting of occlusion. We describe the case of a 75-year-old woman who underwent fenestrated endovascular aneurysm repair and experienced acute anuric renal failure requiring dialysis secondary to bilateral renal artery stent occlusion for >48 hours. She was successfully treated with revisional endovascular therapy and made a full renal recovery.
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Affiliation(s)
- Trishul Kapoor
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Gustavo S Oderich
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Randall R DeMartino
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn.
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7
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Zierler RE, Jordan WD, Lal BK, Mussa F, Leers S, Fulton J, Pevec W, Hill A, Murad MH. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. J Vasc Surg 2018; 68:256-284. [PMID: 29937033 DOI: 10.1016/j.jvs.2018.04.018] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Abstract
Although follow-up after open surgical and endovascular procedures is generally regarded as an important part of the care provided by vascular surgeons, there are no detailed or comprehensive guidelines that specify the optimal approaches with regard to testing methods, indications for reintervention, and follow-up intervals. To provide guidance to the vascular surgeon, the Clinical Practice Council of the Society for Vascular Surgery appointed an expert panel and a methodologist to review the current clinical evidence and to develop recommendations for follow-up after vascular surgery procedures. For those procedures for which high-quality evidence was not available, recommendations were based on observational studies, committee consensus, and indirect evidence. Recognizing that there are numerous published reports on the role of duplex ultrasound for surveillance of infrainguinal vein bypass grafts, the Society commissioned a systematic review and meta-analysis on this topic. The panel classified the strength of each recommendation and the corresponding quality of evidence on the basis of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system: recommendations were graded either strong or weak, and the quality of evidence was graded high, moderate, or low. The resulting recommendations represent a wide variety of open surgical and endovascular procedures involving the extracranial carotid artery, thoracic and abdominal aorta, mesenteric and renal arteries, and lower extremity arterial revascularization. The panel also identified many areas in which there was a lack of high-quality evidence to support their recommendations. This suggests that there are opportunities for further clinical research on testing methods, threshold criteria, and the role of surveillance as well as on the modes of failure and indications for reintervention after vascular surgery procedures.
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Affiliation(s)
| | | | - Brajesh K Lal
- Department of Surgery, University of Maryland, Baltimore, Md
| | - Firas Mussa
- Department of Surgery Palmetto Health/University of South Carolina School of Medicine, Columbia, SC
| | - Steven Leers
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Joseph Fulton
- Department of Surgery, Westchester Medical Center, Poughkeepsie, NY
| | - William Pevec
- Division of Vascular Surgery, University of California, Davis, Sacramento, Calif
| | - Andrew Hill
- Division of Vascular & Endovascular Surgery, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minn
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8
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Jaldin RG, Sobreira ML, Moura R, Bertanha M, Pimenta REF, Yoshida RDA, Mariúba JVDO, Yoshida WB. Tratamento da recidiva de reestenose intra-stent renal por angioplastia com balão farmacológico. J Vasc Bras 2018; 17:81-88. [PMID: 29930687 PMCID: PMC5990271 DOI: 10.1590/1677-5449.005117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nos últimos anos, balões farmacológicos surgiram como promissora alternativa terapêutica em intervenções endovasculares. Com essa tecnologia, transferem-se drogas antiproliferativas à parede arterial, sem a necessidade de implante metálico para liberação. Descreve-se o caso de um paciente com uma segunda recidiva de reestenose intra-stent renal tratada por angioplastia com balão coberto por droga, com boa evolução clínica caracterizada por adequado controle pressórico e redução de classes e dosagem dos anti-hipertensivos. Os resultados obtidos com balões farmacológicos em outros territórios e esta experiência isolada podem contribuir como sugestão para o uso desses dispositivos na reestenose intra-stent renal, com resultados iniciais satisfatórios.
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9
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Mousa AY, Bates MC, Broce M, Bozzay J, Morcos R, AbuRahma AF. Issues related to renal artery angioplasty and stenting. Vascular 2017. [DOI: 10.1177/1708538116677654 10.5414/cn109239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal artery stenosis may play a significant role in the pathogenesis of secondary hypertension, renal dysfunction, and flash pulmonary edema. Currently correction of renal arterial inflow stenosis is reserved for resistant hypertension patients who have failed maximal medical therapy, have worsening renal function and/or unexplained proximal congestive failure. With the recent advances in minimally invasive percutaneous stent placement techniques, open surgical revascularization has been largely replaced by renal artery stenting. The potential benefit of revascularization seemed intuitive; however, the initial enthusiasm and rise in the number of percutaneous interventions have been tempered by many subsequent negative randomized clinical trials that failed to prove the proposed benefits of the percutaneous intervention. The negative randomized trial results have fallen under scrutiny due to trial design concerns and inconsistent outcomes of these studies compared to pivotal trials undertaken under US Food and Drug Administration scrutiny. Treatment of atherosclerotic renal artery occlusive disease has become one of the most debatable topics in the field of vascular disease. The results from recent randomized clinical trials of renal artery stenting have basically limited the utilization of the procedure in many centers, but not every clinical scenario was covered in those trials. There are potential areas for improvement focusing mainly on procedural details and patient selection with respect to catheter based treatment of atherosclerotic renal artery stenosis. We believe, limiting patient selection, enrollment criteria and outcomes measured functioned to reduce the benefit of renal artery stenosis stenting by not enrolling patients likely to benefit. Future studies incorporating potential procedural improvements and that include patients more likely to benefit from renal stenting than were included in ASTRAL and CORAL are needed to more carefully examine specific patient subgroups so that “the baby is not thrown out with the bath water.” We also discuss several other concerns related to renal artery stenting which include diagnostic, procedure, indication, and reimbursement issues.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
| | - Mark C Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
| | - Mike Broce
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Joseph Bozzay
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ramez Morcos
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Internal Medicine Department, Boca Raton, FL, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
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10
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Mousa AY, Bates MC, Broce M, Bozzay J, Morcos R, AbuRahma AF. Issues related to renal artery angioplasty and stenting. Vascular 2017; 25:618-628. [PMID: 28782453 DOI: 10.1177/1708538116677654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal artery stenosis may play a significant role in the pathogenesis of secondary hypertension, renal dysfunction, and flash pulmonary edema. Currently correction of renal arterial inflow stenosis is reserved for resistant hypertension patients who have failed maximal medical therapy, have worsening renal function and/or unexplained proximal congestive failure. With the recent advances in minimally invasive percutaneous stent placement techniques, open surgical revascularization has been largely replaced by renal artery stenting. The potential benefit of revascularization seemed intuitive; however, the initial enthusiasm and rise in the number of percutaneous interventions have been tempered by many subsequent negative randomized clinical trials that failed to prove the proposed benefits of the percutaneous intervention. The negative randomized trial results have fallen under scrutiny due to trial design concerns and inconsistent outcomes of these studies compared to pivotal trials undertaken under US Food and Drug Administration scrutiny. Treatment of atherosclerotic renal artery occlusive disease has become one of the most debatable topics in the field of vascular disease. The results from recent randomized clinical trials of renal artery stenting have basically limited the utilization of the procedure in many centers, but not every clinical scenario was covered in those trials. There are potential areas for improvement focusing mainly on procedural details and patient selection with respect to catheter based treatment of atherosclerotic renal artery stenosis. We believe, limiting patient selection, enrollment criteria and outcomes measured functioned to reduce the benefit of renal artery stenosis stenting by not enrolling patients likely to benefit. Future studies incorporating potential procedural improvements and that include patients more likely to benefit from renal stenting than were included in ASTRAL and CORAL are needed to more carefully examine specific patient subgroups so that "the baby is not thrown out with the bath water." We also discuss several other concerns related to renal artery stenting which include diagnostic, procedure, indication, and reimbursement issues.
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Affiliation(s)
- Albeir Y Mousa
- 1 Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
| | - Mark C Bates
- 1 Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
| | - Mike Broce
- 2 Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Joseph Bozzay
- 3 Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ramez Morcos
- 4 Florida Atlantic University, Charles E. Schmidt College of Medicine, Internal Medicine Department, Boca Raton, FL, USA
| | - Ali F AbuRahma
- 1 Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
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11
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Iancu AC, Bălănescu Ș, Marc M, Homorodean C, Bindea D, Reimers B, Civilini E, Torsello G, Castriota F, Nerla R, Micari A, Cremonesi A. How should I treat renal artery in-stent restenosis and stent fracture after endovascular abdominal aortic aneurysm repair? EUROINTERVENTION 2016; 12:1312-1316. [PMID: 27866143 DOI: 10.4244/eijv12i10a216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Yu MS, Xiang K, Haller ST, Cooper CJ. Renal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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13
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Treatment of In-Stent Restenosis in Patients with Renal Artery Stenosis. J Vasc Interv Radiol 2016; 27:1657-1662. [PMID: 27503035 DOI: 10.1016/j.jvir.2016.05.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/28/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine clinical outcomes of patients treated for renal artery in-stent restenosis (ISR) with atherosclerotic renal artery stenosis. MATERIALS AND METHODS A retrospective review was performed of the clinical data of all patients who underwent renal artery stent placement for atherosclerotic renal artery stenosis from 1996 to 2009. Medical records of patients were reviewed for relevant clinical history, including blood pressure, antihypertensive medications, and renal function data before and after an intervention. In 1,052 patients, 1,090 renal artery stent placements were performed. Of these, 101 stents in 79 patients developed ISR, which was treated with either percutaneous transluminal angioplasty (PTA) or repeat stent placement. Procedural details, including modality of intervention, stent diameter, and time to restenosis, were recorded. Hypertensive agent and use of statins were recorded. Univariate analysis was performed to identify risk factors associated with restenosis after treatment of ISR. RESULTS Patients treated with repeat stent placement were 6.89 times more likely to lose patency after treatment than patients treated with PTA (P < .01). No additional clinical or procedural factor, including smoking history; presence of cardiac, renal, or metabolic disease; use of statin at time of ISR treatment; or diameter of treatment (stent or PTA), had a significant association with duration of stent or angioplasty patency. CONCLUSIONS Treatment of renal artery ISR with PTA among patients with atherosclerotic renal artery stenosis has a lower rate of subsequent ISR compared with repeat stent placement.
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14
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Renal artery stenting in a 2-year-old child with resistant hypertension and neurofibromatosis. Cardiovasc Interv Ther 2016; 32:274-278. [PMID: 27448024 DOI: 10.1007/s12928-016-0415-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
The occurrence of vascular lesions in neurofibromatosis is uncommon but well documented. These vascular lesions when present, occur predominantly in the kidneys, endocrine glands, heart and gastrointestinal tract, causing stenosis or obliteration of the lumen. We report a case of uncontrolled resistant hypertension in a 2-year-old child presenting with neurofibromatosis who was found to have a high-grade ostial left renal artery stenosis and obliteration of the right renal artery. As the right kidney was small and hypo-functioning, and its renal artery was totally occluded, we subjected the child to a left renal angioplasty and bailout stenting. Following stenting, the blood pressure decreased with anti-hypertensive treatment. Based on a review of the literature, and to the best of our knowledge, this is the youngest child to have undergone renal artery stenting.
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15
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Arce-Santiago M, Rodríguez-Cruz E. Treatment of a recurrent renal artery stenosis and stent fracture using a drug eluting stent in a pediatric patient. CEN Case Rep 2016; 5:18-22. [PMID: 28509158 PMCID: PMC5413738 DOI: 10.1007/s13730-015-0182-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/08/2015] [Indexed: 10/23/2022] Open
Abstract
Renal artery obstruction is uncommon in the pediatric population and therefore represents a challenging diagnosis to ascertain and treat. While angioplasty and surgery have been used to treat it, stent implantation has been left mainly for adult use. In the following paper, we expose the case of an 8-year-old female who presented with severe arterial hypertension. Initially, the patient was evaluated and up to 5 antihypertensive medications were started. After complete evaluation, she was found to have severe right renal artery distal and proximal stenosis. She underwent recurrent angioplasties and then a bare metal stent (BMS) implantation, due to recurrence of stenosis. The original BMS developed a circumferential fracture, leading to a second stent implant, this time using a drug eluting stent (DES). She has been stable for 8 years since the last intervention, although using 2 antihypertensive medications. The use of BMS and DES may add another tool in the armamentarium of the pediatric interventionist to treat these children with recurrent stenosis that fail angioplasty.
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Affiliation(s)
| | - Edwin Rodríguez-Cruz
- Interventional Cardiology and Internal Medicine, Division of Cardiology, Cardiovascular Center of Puerto Rico and the Caribbean, San Juan, PR, USA.
- Section of Cardiology, San Jorge Children's Hospital, San Juan, PR, USA.
- , 270 Convento Street, Suite #1, Floor #1, San Juan, 00912, USA.
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16
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Heneghan RE, Starnes BW, Nathan DP, Zierler RE. Renal duplex ultrasound findings in fenestrated endovascular aortic repair for juxtarenal aortic aneurysms. J Vasc Surg 2016; 63:915-21. [DOI: 10.1016/j.jvs.2015.10.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/21/2015] [Indexed: 01/23/2023]
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17
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Silverman SH, Exline JB, Silverman LN, Samson RH. Endovascular brachytherapy for renal artery in-stent restenosis. J Vasc Surg 2014; 60:1599-604. [DOI: 10.1016/j.jvs.2014.08.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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19
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Martinelli O, Malaj A, Antignani PL, Frati G, Belli C, Venosi S, Irace L, Gossetti B, Gattuso R. Renal Stenting for Kidney Salvage in the Management of Renal Artery Atherosclerotic Stenosis. Angiology 2014; 66:785-91. [PMID: 25274528 DOI: 10.1177/0003319714553005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied the usefulness of preoperative resistance index to select patients who will benefit most from renal stenting. Sixty-two patients underwent renal stenting. All had chronic renal insufficiency with serum creatinine values ranging from 1.5 to 2.5 mg/dL and blood urea nitrogen between 80 and 107 mg/dL. All treated renal artery stenosis were >70%. Reduction in blood pressure in the early stages was observed in 39 (62.9%) patients; 31 (79.4%) patients returned to preoperative values within 12 months. A progressive reduction in creatinine values and blood urea nitrogen was reached in 43 (69.4%) patients, 12 (19.4%) patients remained unchanged, and the remaining 7 (11.2%) patients worsened. The best improvement in renal function was obtained in patients with a resistance index of ≤0.75 A preoperative resistance index up to 0.75 could be used as an indicator to predict which candidates will have improved renal function after stenting.
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Affiliation(s)
- O Martinelli
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
| | - A Malaj
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
| | - P L Antignani
- Department of Angiology, "San Giovanni Addolorata" Hospital, Rome, Italy
| | - G Frati
- Department of Biotechnology and Medical-Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - C Belli
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
| | - S Venosi
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
| | - L Irace
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
| | - B Gossetti
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
| | - R Gattuso
- Vascular Surgery, "Sapienza" University Rome, Rome, Italy
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Campbell JE, Stone PA, Bates MC. Technical discussion of diagnostic angiography and intervention of atherosclerotic renal artery stenosis. Semin Vasc Surg 2014; 26:150-60. [PMID: 25220320 DOI: 10.1053/j.semvascsurg.2014.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Renal artery stenting remains an important adjuvant treatment for true-resistant hypertension, although recent disappointing randomized trials highlight the importance of careful patient selection. Safe and successful renal interventions begin with critical core knowledge regarding renal artery anatomy and understanding the often hostile nature of the parent vessel (pararenal aorta). Armed with fundamental knowledge about anatomy and renal ostial disease pathology, it becomes easier to understand the advantages of less traumatic access techniques and how low-profile contemporary flexible stents have enhanced outcomes. In addition to suggested techniques based on detailed understanding of the vessel architecture and pathology, we will review the current available US Food and Drug Administration-approved balloon-expandable on-label renal stents and discuss the role of intravascular ultrasound for definition of lesion severity, stent sizing, and stent apposition. The durability of renal stenting will also be discussed, as will the velocity criteria for duplex surveillance. Lastly, the current empirical data related to renal embolic protection is provided, along with insight into technical issues in this domain.
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Affiliation(s)
- John E Campbell
- Department of Surgery, West Virginia University Division of Vascular and Endovascular Surgery, Vascular Center of Excellence, Charleston Area Medical Center, 3100 MacCorkle Avenue SE, Charleston, West Virginia 25304.
| | - Patrick A Stone
- Department of Surgery, West Virginia University Division of Vascular and Endovascular Surgery, Vascular Center of Excellence, Charleston Area Medical Center, 3100 MacCorkle Avenue SE, Charleston, West Virginia 25304
| | - Mark C Bates
- Department of Surgery, West Virginia University Division of Vascular and Endovascular Surgery, Vascular Center of Excellence, Charleston Area Medical Center, 3100 MacCorkle Avenue SE, Charleston, West Virginia 25304
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22
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Clinical effectiveness of secondary interventions for restenosis after renal artery stenting. J Vasc Surg 2013; 58:687-94. [PMID: 23688626 DOI: 10.1016/j.jvs.2013.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Secondary interventions for renal artery restenosis (RAS) after renal artery stenting are common, despite limited data about their effectiveness. This study was designed to evaluate the outcomes of endovascular treatment of recurrent RAS. METHODS We conducted a retrospective review of patients who underwent renal artery stenting between 2001 and 2011 at Dartmouth-Hitchcock Medical Center. Patients who required secondary interventions were compared with control patients who underwent only primary interventions for RAS. Multivariate regression models were used to identify factors associated with successful outcomes, as measured by changes in blood pressure, estimated glomerular filtration rate, and number of antihypertensive medications required. RESULTS Sixty-five secondary (57 patients) renal interventions were undertaken for recurrent RAS associated with progressive hypertension or renal dysfunction and compared with outcomes after 216 primary (180 patients) renal artery stenting procedures. Patients undergoing primary vs secondary interventions did not differ significantly in the number of preoperative antihypertensive medications used, comorbid conditions, or blood pressure. All primary and secondary interventions were performed with stents and showed no difference in procedural complications. At a mean follow-up of 23 months (range, 1-128 months), similar improvements in renal function and blood pressure were found between patients undergoing primary and secondary interventions, and there was no difference in rates of restenosis or survival between cohorts. Regression models showed that the use of embolic protection devices was associated with improved renal function after primary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.8; P < .05) and secondary (OR, 4.7; 95% CI, 1.7-12.5; P < .05) interventions, whereas statin therapy was associated with improved renal (OR, 2.0; 95% CI, 1.3-3.2; P < .05) and blood pressure response (OR, 4.1; 95% CI, 1.1-14.9; P < .05) after secondary interventions. CONCLUSIONS Patients undergoing secondary interventions for recurrent RAS have outcomes that are comparable with those for primary interventions. These data suggest that repeated endovascular procedures for RAS can be undertaken with similar expectations for clinical improvement and may be further improved by routine use of embolic protection devices and statin therapy.
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Boateng FK, Greco BA. Renal artery stenosis: prevalence of, risk factors for, and management of in-stent stenosis. Am J Kidney Dis 2012; 61:147-60. [PMID: 23122491 DOI: 10.1053/j.ajkd.2012.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 07/17/2012] [Indexed: 11/11/2022]
Abstract
Atherosclerotic renal artery stenosis is common and is associated with hypertension and chronic kidney disease. More frequent use of percutaneous renal artery stent placement for the treatment of renal artery stenosis during the past 2 decades has increased the number of patients with implanted stents. In-stent stenosis is a serious problem, occurring more frequently than earlier reports suggest and potentially resulting in late complications. Currently, there are no guidelines covering the approach to restenosis after renal artery stent placement. This article reviews data on the prevalence of and risk factors for the development of in-stent stenosis and the clinical manifestations, evaluation, and treatment of in-stent stenosis and suggests a strategy for the management of patients after percutaneous renal artery stent placement.
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Affiliation(s)
- Frank K Boateng
- Indiana University, Bloomington Hospital, Bloomington, IN, USA
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Clopidogrel use before renal artery angioplasty with/without stent placement resulted in tertiary procedure risk reduction. J Vasc Surg 2012; 56:416-23. [PMID: 22560231 DOI: 10.1016/j.jvs.2012.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/12/2011] [Accepted: 01/06/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Contrary to coronary artery literature, the effect of preprocedural clopidogrel on renal artery restenosis (RAR) has not been characterized. This study was designed to evaluate the effect of preprocedural clopidogrel on target vessel revascularization (TVR), reintervention, and restenosis for patients who underwent recurrent renal artery angioplasty. METHODS A retrospective analysis of patients treated for RAR in a single tertiary center from January 1999 to December 2009 was conducted. Patients were divided into preadmission use of (1) clopidogrel or (2) aspirin only (acetylsalicylic acid [ASA]) for the initial procedure. TVR was defined as occurrence of a tertiary procedure for symptomatic RAR. Rate of freedom from event (ie, tertiary restenosis and TVR) was analyzed using Kaplan-Meier method. RESULTS Eighty-eight interventions were performed on 77 patients with RAR; 66% were females with average (mean ± SEM) age and body mass index of 68.8 ± 1.1 and 28.6 ± 0.8, respectively. Comorbidities included 96% chronic hypertension, 33% diabetes, 76% hyperlipidemia, 20% renal insufficiency, 39% tobacco use, 58% coronary artery disease, and 51% peripheral vascular disease. Clopidogrel use increased significantly during the index procedure from admission 35.2% to discharge 97.7% (P < .001, McNemar test). There was a trend toward risk reduction of a tertiary intervention (23%) for patients admitted on clopidogrel compared with ASA (P = .052). Likewise, there was a trend (P = .051) toward increased freedom from a tertiary intervention, with cumulative freedom at 8 years 93.5% for clopidogrel vs 61% for ASA. No differences were found for restenosis. CONCLUSIONS The use of preprocedural clopidogrel was associated with a possible risk reduction of TVR reintervention, but this finding needs to be validated in randomized clinical trial.
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Rump LC, Sellin L. [Medicinal or instrumental (corrected) therapy of renal artery stenosis?]. Internist (Berl) 2012; 53:760-5. [PMID: 22450771 DOI: 10.1007/s00108-012-3038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arteriosclerotic renal artery stenosis (RAS) has an increased incidence in patients with cardiovascular risk factors. Clinically RAS presents in some patients as secondary, sometimes resistant arterial hypertension and in others as chronic renal insufficiency, sometimes with acute renal failure and in a third group both symptoms are observed. Doppler ultrasound plays a central role in the diagnosis of RAS. Therapeutically, it is important to identify hemodynamically relevant RAS before interventional therapy is initiated. The therapy of RAS has been under intensive debate since the publication of randomized controlled trials (RCT) which showed that only a subset of RAS can be successfully treated by interventional therapy. Since then the medicinal therapy of RAS has gained more and more impact. The following questions are raised: which forms of RAS can be treated by which therapy? What is the best medicinal therapy to treat RAS? What substances are recommended?
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Affiliation(s)
- L C Rump
- Klinik für Nephrologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany.
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Mousa AY, Campbell JE, Stone PA, Broce M, Bates MC, AbuRahma AF. Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period. J Vasc Surg 2012; 55:421-7. [DOI: 10.1016/j.jvs.2011.09.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 11/29/2022]
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Abstract
Renal artery intervention to treat hypertension is one of the frontiers of ongoing research in combating this epidemic. This article focuses on recent data regarding PTRS and catheter-based renal sympathetic denervation. Despite progress in this field large multicenter, randomized trials that compare these treatment modalities with medical therapy for hypertension are lacking.
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Affiliation(s)
- Rajan A G Patel
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Antiplatelets treatment in atherosclerotic renal artery stenosis: need of consensus-based recommendations. J Hypertens 2011; 29:2279-81. [PMID: 21989383 DOI: 10.1097/hjh.0b013e32834c1e13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tallarita T, Oderich GS, Macedo TA, Gloviczki P, Misra S, Duncan AA, Kalra M, Bower TC. Reinterventions for stent restenosis in patients treated for atherosclerotic mesenteric artery disease. J Vasc Surg 2011; 54:1422-1429.e1. [PMID: 21963821 DOI: 10.1016/j.jvs.2011.06.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Mesenteric artery angioplasty and stenting (MAS) has been plagued by high restenosis and reintervention rates. The purpose of this study was to review the outcomes of patients treated for mesenteric artery in-stent restenosis (MAISR). METHODS The clinical data of 157 patients treated for chronic mesenteric ischemia with MAS of 170 vessels was entered into a prospective database (1998-2010). Fifty-seven patients (36%) developed MAISR after a mean follow-up of 29 months, defined by duplex ultrasound peak systolic velocity >330 cm/s and angiographic stenosis >60%. We reviewed the clinical data, radiologic studies, and outcomes of patients who underwent reintervention for restenosis. End points were mortality and morbidity, patient survival, symptom recurrence, reintervention, and patency rates. RESULTS There were 30 patients (25 female and five male; mean age, 69 ± 14 years) treated with reintervention for MAISR. Twenty-four patients presented with recurrent symptoms (21 chronic, three acute), and six had asymptomatic preocclusive lesions. Twenty-six patients (87%) underwent redo endovascular revascularization (rER) with stent placement in 17 (13 bare metal and four covered) or percutaneous transluminal angioplasty (PTA) in nine. The other four patients (13%) had open bypass, one for acute ischemia. There was one death (3%) in a patient treated with redo stenting for acute mesenteric ischemia. Seven patients (27%) treated by rER developed complications, including access site problems in four patients, and distal embolization with bowel ischemia, congestive heart failure and stent thrombosis in one each. Symptom improvement was noted in 22 of the 24 symptomatic patients (92%). After a mean follow-up of 29 ± 12 months, 15 patients (50%) developed a second restenosis, and seven (23%) required other reintervention. Rates of symptom recurrence, restenosis, and reinterventions were 0/4, 0/4, and 0/4 for covered stents, 2/9, 3/9, and 2/9 for PTA, 5/13, 8/13, and 5/13 for bare metal stents, and 1/4, 4/4, and 0/4 for open bypass. For all patients, freedom from recurrent symptoms, restenosis, and reinterventions were 70% ± 10%, 60% ± 10% and 50% ±10% at 2 years. For patients treated by rER, secondary patency rates were 72 ± 12 at the same interval. CONCLUSIONS Nearly 40% of patients developed mesenteric artery in-stent restenosis, of which half required reintervention because of symptom recurrence or progression to an asymptomatic preocclusive lesion. Mesenteric reinterventions were associated with low mortality (3%), high complication rate (27%), and excellent symptom improvement (92%).
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Affiliation(s)
- Tiziano Tallarita
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, Minn, USA
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