BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have report...BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have reported the use of drug coated balloon angioplasty in the treatment of Takayasu arteritis. We aimed to demonstrate five young female patients who presented with a history of hypertension due to Takayasu arteritis. CASE SUMMARY From April 2017 to October 2018, five female patients were diagnosed with hypertension due to Takayasu arteritis by computed tomography angiography (CTA) and laboratory tests. Four patients had a complaint of headache with or without dizziness, and one patient showed no symptom. There was no significant family or past history of hypertension or kidney disease, and the physical examinations were almost normal on admission. We performed a treatment by drug coated balloon angioplasty. Blood pressure decreased dramatically in all patients after balloon angioplasty, and the patency of treated renal artery was demonstrated with CTA over 5 months after the angioplasty procedure. CONCLUSION Drug coated balloon angioplasty is safe and effective for renal artery stenosis due to Takayasu arteritis. A prospective study with a larger sample size is necessary to further demonstrate the effectiveness of the treatment.展开更多
The effects of the renal artery stenosis （RAS） on the blood flow and vessel walls are investigated. The pulsatile blood flow through an anatomically realistic model of the abdominal aorta and renal arteries reconstr...The effects of the renal artery stenosis （RAS） on the blood flow and vessel walls are investigated. The pulsatile blood flow through an anatomically realistic model of the abdominal aorta and renal arteries reconstructed from CT-scan images is simulated, which incorporates the fluid-structure interaction （FSI）. In addition to the investigation of the RAS effects on the wall shear stress and the displacement of the vessel wall, it is determined that the RAS leads to decrease in the renal mass flow. This may cause the activation of the renin-angiotension system and results in severe hypertension.展开更多
Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomos...Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS.展开更多
Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a ca...Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a case of early TRAS detected 6 hours after a successful renal transplant. Renal angiography showed complete stenosis of the internal iliac to renal artery anastomosis. Percutaneous transplant artery angioplasty was attempted, but was not successful;hence the surgical correction of the same was done. This is to demonstrate the use of saphenous vein bypass of anastomotic obstruction of the previous anastomosis, in case of short renal artery.展开更多
A 40-year-old woman was referred for resistant hypertension despite three anti-hypertensive medications including a diuretic at maximum tolerated dose.She has no family history of fibromuscular dysplasia(FMD).Contrast...A 40-year-old woman was referred for resistant hypertension despite three anti-hypertensive medications including a diuretic at maximum tolerated dose.She has no family history of fibromuscular dysplasia(FMD).Contrast-enhanced computed tomography showed right renal artery stenosis suspicious of FMD.展开更多
BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation.However,extra-renal pseudo-aneurysms(EPSAs)are rare after transplantation;they can be life-threatening a...BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation.However,extra-renal pseudo-aneurysms(EPSAs)are rare after transplantation;they can be life-threatening and usually need open surgical repair.We discuss the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis,which was diagnosed in a timely manner and managed by conservative treatments.CASE SUMMARY We present a 37-year-old male patient diagnosed with a renal allograft EPSA caused by renal artery anastomotic stenosis due to multiple atherosclerotic plaques with ultrasonographic examination 6 mo post transplantation.The stenosis rate of 90%and the EPSA were verified by computed tomography angiography.The diagnosis was further confirmed with digital subtraction angiography.Percutaneous transluminal angiography was conducted,and a metallic stent was successfully implanted at the stenosed site of the main renal artery trunk.No further intervention for the EPSA was undertaken due to the difficulty of stenting and the risk of bleeding;regular ultrasonographic follow-ups were recommended.The stenosis was significantly relieved immediately after stent implantation and the EPSA was healed spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting.CONCLUSION Ultrasonography combined with a high-frequency linear probe can detect vascular complications post renal transplantation at an early stage and improve prognosis.展开更多
Objective To evaluate the effect of revascularization of the renal artery on urinary microglobulin in patients with coronaryartery disease and significant renal artery stenosis(RAS).Methods Forty-four patients with co...Objective To evaluate the effect of revascularization of the renal artery on urinary microglobulin in patients with coronaryartery disease and significant renal artery stenosis(RAS).Methods Forty-four patients with coronary artery disease and severe RAS(luminal narrowing>70%)underwent percutaneous transluminal renal artery angioplasty(PTRA)and stenting,as well as percutaneous coronary intervention.The urine-microglobulin(α_(1)-MG)andβ_(2)-Cmicroglobulin(β_(2)-MG)at baseline and at 3 months after the procedures were measured.Procedural success rate,procedural complications,serum creatinine concentration at baseline and at 3-months were also recorded.Results At 3-months after the renal revascularization therapy,there was no significant change of urineα_(1)-MG ompared with that of the baseline,however,the urineβ_(2)-MG decreased significantly 3-months after the treatment(237±187μg/L vs 377±173μg/L,P<0.01).Multivariate analysis revealed that persistent elevation of urine was an independent predictor of severe events(including re-admission and renal failure)after renal revascularization therapy in patients with severe RAS(OR=3.01,95%CI 1.01-8.95,P=0.036).Conclusions In patients with coronary artery disease and severe RAS,revascularization with PTRA and stenting may improve renal tubular function,but a continuous high level of urinary microglobulins after intervention is associated with more frequent re-hospitalization and renal failure.展开更多
BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are fr...BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.展开更多
Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus...Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.展开更多
Background： Previous data are controversial about the association of renal artery stenosis （RAS） with clinical outcome in patients with heart failure. Definition of RAS in previous studies might not be appropriate....Background： Previous data are controversial about the association of renal artery stenosis （RAS） with clinical outcome in patients with heart failure. Definition of RAS in previous studies might not be appropriate. By definition of RAS with renal duplex sonography, we investigated the association of RAS with clinical outcome in patients with heart failure. Methods： In this retrospective study, we identified 164 patients with heart failure （New York Heart Association classification ≥11; left ventricular ejection fraction 〈50%） who had received renal duplex sonography during hospital stay. RAS was defined as renal-aortic ratio 〉3.5 or a peak systolic velocity ≥200 cm/s （or both）, or occlusion of the renal artery. Categorical data of patients were compared using the Chi-square test or Fisher＇s exact test. Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors. Results： Finally, 143 patients were enrolled, Median follow-up time was 32 months （1-53 months）. Twenty-two patients were diagnosed as RAS by renal duplex sonography, including 13 unilateral RAS （3 left RAS, l0 right RAS） and 9 bilateral RAS. There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS. By multivariate analysis, RAS was a significant predictor for all-cause death and cardiovascular death （hazard ratio [HR] = 4.155, 95% confidence interval [（7/]： 1.546-1 1. 164, P = 0.005; and MR = 3.483, 95% CI： 1.200-10.104, P = 0.022, respectively）. As for composite endpoint events, including death, nonfatal myocardial infarction, ischemic stroke or intracranial hemorrhage, rehospitalization for cardiac failure, and renal replacement therapy, only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor. RAS was not a significant predictor for composite endpoint events. Conclusions： Our data suggested that RAS is associated with a poorer clinical outcome in patients with heart failure.展开更多
基金Supported by the National Natural Science Foundation of China,No.81501569
文摘BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have reported the use of drug coated balloon angioplasty in the treatment of Takayasu arteritis. We aimed to demonstrate five young female patients who presented with a history of hypertension due to Takayasu arteritis. CASE SUMMARY From April 2017 to October 2018, five female patients were diagnosed with hypertension due to Takayasu arteritis by computed tomography angiography (CTA) and laboratory tests. Four patients had a complaint of headache with or without dizziness, and one patient showed no symptom. There was no significant family or past history of hypertension or kidney disease, and the physical examinations were almost normal on admission. We performed a treatment by drug coated balloon angioplasty. Blood pressure decreased dramatically in all patients after balloon angioplasty, and the patency of treated renal artery was demonstrated with CTA over 5 months after the angioplasty procedure. CONCLUSION Drug coated balloon angioplasty is safe and effective for renal artery stenosis due to Takayasu arteritis. A prospective study with a larger sample size is necessary to further demonstrate the effectiveness of the treatment.
文摘The effects of the renal artery stenosis （RAS） on the blood flow and vessel walls are investigated. The pulsatile blood flow through an anatomically realistic model of the abdominal aorta and renal arteries reconstructed from CT-scan images is simulated, which incorporates the fluid-structure interaction （FSI）. In addition to the investigation of the RAS effects on the wall shear stress and the displacement of the vessel wall, it is determined that the RAS leads to decrease in the renal mass flow. This may cause the activation of the renin-angiotension system and results in severe hypertension.
文摘Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS.
文摘Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a case of early TRAS detected 6 hours after a successful renal transplant. Renal angiography showed complete stenosis of the internal iliac to renal artery anastomosis. Percutaneous transplant artery angioplasty was attempted, but was not successful;hence the surgical correction of the same was done. This is to demonstrate the use of saphenous vein bypass of anastomotic obstruction of the previous anastomosis, in case of short renal artery.
文摘A 40-year-old woman was referred for resistant hypertension despite three anti-hypertensive medications including a diuretic at maximum tolerated dose.She has no family history of fibromuscular dysplasia(FMD).Contrast-enhanced computed tomography showed right renal artery stenosis suspicious of FMD.
基金the Funding from Beijing Municipal Administration of Hospitals’Ascent Plan,No.DFL 20180102and the Capital's Funds for Health Improvement and Research,No.2020-4-20211.
文摘BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation.However,extra-renal pseudo-aneurysms(EPSAs)are rare after transplantation;they can be life-threatening and usually need open surgical repair.We discuss the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis,which was diagnosed in a timely manner and managed by conservative treatments.CASE SUMMARY We present a 37-year-old male patient diagnosed with a renal allograft EPSA caused by renal artery anastomotic stenosis due to multiple atherosclerotic plaques with ultrasonographic examination 6 mo post transplantation.The stenosis rate of 90%and the EPSA were verified by computed tomography angiography.The diagnosis was further confirmed with digital subtraction angiography.Percutaneous transluminal angiography was conducted,and a metallic stent was successfully implanted at the stenosed site of the main renal artery trunk.No further intervention for the EPSA was undertaken due to the difficulty of stenting and the risk of bleeding;regular ultrasonographic follow-ups were recommended.The stenosis was significantly relieved immediately after stent implantation and the EPSA was healed spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting.CONCLUSION Ultrasonography combined with a high-frequency linear probe can detect vascular complications post renal transplantation at an early stage and improve prognosis.
文摘Objective To evaluate the effect of revascularization of the renal artery on urinary microglobulin in patients with coronaryartery disease and significant renal artery stenosis(RAS).Methods Forty-four patients with coronary artery disease and severe RAS(luminal narrowing>70%)underwent percutaneous transluminal renal artery angioplasty(PTRA)and stenting,as well as percutaneous coronary intervention.The urine-microglobulin(α_(1)-MG)andβ_(2)-Cmicroglobulin(β_(2)-MG)at baseline and at 3 months after the procedures were measured.Procedural success rate,procedural complications,serum creatinine concentration at baseline and at 3-months were also recorded.Results At 3-months after the renal revascularization therapy,there was no significant change of urineα_(1)-MG ompared with that of the baseline,however,the urineβ_(2)-MG decreased significantly 3-months after the treatment(237±187μg/L vs 377±173μg/L,P<0.01).Multivariate analysis revealed that persistent elevation of urine was an independent predictor of severe events(including re-admission and renal failure)after renal revascularization therapy in patients with severe RAS(OR=3.01,95%CI 1.01-8.95,P=0.036).Conclusions In patients with coronary artery disease and severe RAS,revascularization with PTRA and stenting may improve renal tubular function,but a continuous high level of urinary microglobulins after intervention is associated with more frequent re-hospitalization and renal failure.
文摘BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.
文摘Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.
文摘Background： Previous data are controversial about the association of renal artery stenosis （RAS） with clinical outcome in patients with heart failure. Definition of RAS in previous studies might not be appropriate. By definition of RAS with renal duplex sonography, we investigated the association of RAS with clinical outcome in patients with heart failure. Methods： In this retrospective study, we identified 164 patients with heart failure （New York Heart Association classification ≥11; left ventricular ejection fraction 〈50%） who had received renal duplex sonography during hospital stay. RAS was defined as renal-aortic ratio 〉3.5 or a peak systolic velocity ≥200 cm/s （or both）, or occlusion of the renal artery. Categorical data of patients were compared using the Chi-square test or Fisher＇s exact test. Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors. Results： Finally, 143 patients were enrolled, Median follow-up time was 32 months （1-53 months）. Twenty-two patients were diagnosed as RAS by renal duplex sonography, including 13 unilateral RAS （3 left RAS, l0 right RAS） and 9 bilateral RAS. There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS. By multivariate analysis, RAS was a significant predictor for all-cause death and cardiovascular death （hazard ratio [HR] = 4.155, 95% confidence interval [（7/]： 1.546-1 1. 164, P = 0.005; and MR = 3.483, 95% CI： 1.200-10.104, P = 0.022, respectively）. As for composite endpoint events, including death, nonfatal myocardial infarction, ischemic stroke or intracranial hemorrhage, rehospitalization for cardiac failure, and renal replacement therapy, only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor. RAS was not a significant predictor for composite endpoint events. Conclusions： Our data suggested that RAS is associated with a poorer clinical outcome in patients with heart failure.
