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.

Adolescent↗

PubMedDate not supplied

[Renovascular hypertension: diagnostic and therapeutic strategy].

Investigations for renal artery stenosis have been greatly facilitated by advances in imaging techniques. Intravenous digital subtraction angiography is now performed in all patients with progressive, drug-resistant hypertension associated with aorto-iliac lesions or with renal impairment induced by angiotensin-converting enzyme inhibitors. Yet the finding of hypertension with renal artery stenosis is not enough to make the diagnosis of renovascular hypertension, this term being reserved to hypertension reversible by revascularization. The selection of patients who may benefit from revascularization rests on urography to explore the excretory and endocrine functions of the ischaemic kidney, as well as on scintigraphy and measurement of renin levels in renal veins before and after administration of captopril. The functional data are completed by vascular exploration which helps in evaluating the usefulness and safety of revascularization: repercussions of hypertension on target organs and extension of the vascular disease to other territories. Revascularization as first-line treatment consists of percutaneous transluminal dilatation; surgery must be reserved to difficult cases, such as arterial obliteration or failed dilatation.

Angiography, Digital Subtraction↗

PubMedDate not supplied

Thromboaspiration to treat inadvertent arterial emboli during dialysis graft declotting.

Explore the source record for details and available documents.

Embolism↗

PubMedDate not supplied

Diagnosis and treatment of renin-secreting tumors. Report of three cases.

During the past 10 years, we have found renin-secreting renal juxtaglomerular cell tumors in three hypertensive patients (two women, one man, aged 22, 69, and 21 years, respectively). The major chemical and biological findings revealed the association of severe hypertension with hypokalemia and increased plasma renin activity and plasma aldosterone. The diagnosis of such tumors is difficult, and two of the three patients were followed up for four and five years respectively before undergoing surgery. The pharmacological blockade of the renin system by various agents (beta-blockers, angiotensin II antagonists, and captopril) and its effects on blood pressure and plasma renin activity proved to be unreliable. Renal venous catheterization for renin measurements failed to provide adequate localization of the tumor. Direct radioimmunoassay, however, showed the total plasma renin to be markedly elevated. In addition, renal arteriography showed an avascular area corresponding to the renin-secreting tumor in each of the three patients. All three patients were cured of hypertension and hypokalemia by excision of the tumor.

Adult↗

PubMedDate not supplied

The benefit of STent placement and blood pressure and lipid-lowering for the prevention of progression of renal dysfunction caused by Atherosclerotic ostial stenosis of the Renal artery. The STAR-study: rationale and study design.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is associated with progressive loss of renal function and is one of the most important causes of renal failure in the elderly. Current treatment includes restoration of the renal arterial lumen by endovascular stent placement. However, this treatment only affects damage caused by ARAS due to the stenosis and ensuing post-stenotic ischemia. ARAS patients have severe general vascular disease. Atherosclerosis and hypertension can also damage the kidney parenchyma causing renal failure. Medical treatment focuses on the latter. Lipid-lowering drugs (statins) could reduce renal failure progression and could reduce the overall high cardiovascular risk. The additional effect on preserving renal function of stent placement as compared to medical therapy alone is unknown. Therefore, the STAR-study aims to compare the effects of renal artery stent placement together with medication vs. medication alone on renal function in ARAS patients. METHOD: Patients with an ARAS of > or = 50% and renal failure (creatinine (Cr) clearance < 80 mL/min/1.73 m2) are randomly assigned to stent placement with medication or to medication alone. Medication consists of statins, anti-hypertensive drugs and antiplatelet therapy. Patients are followed for 2 yrs with extended follow-up to 5 yrs. The primary outcome of this study is a reduction in Cr clearance > 20% compared to baseline. This trial will include 140 patients.

Angioplasty, Balloon↗

PubMedDate not supplied

[Comparative study of the carrying out of iliac angioplasty with digital and conventional angiography. Impact on real (consumable) costs].

Differences in time and cost were evaluated between the performance of iliac angioplasty with conventional (AC) and digital subtraction (AN) angiography, after a total of 27 angioplasties (13 with AC and 14 with AN). Excluding amortization of material and personnel costs, findings confirmed a certain number of advantages for AN: gain in time of about 34%, decrease of about 14% in charges, and notably of 83% in expenditure on films and 50% on contrast media.

Angiography↗